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General NPI Number Information
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NPI Number | 1356538821
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Entity Type | Organization
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Legal Business Name | TREASURE COAST PEDORTHICS INC
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Dates
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Enumeration Date | 09/28/2007
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Last Update Date | 12/07/2015
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Provider Practice Location Address
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Address Line | 2686 US HIGHWAY 1
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City | VERO BEACH
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State | FL
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Zip | 32960-5080
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Country | US
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Telephone | 772-562-9045
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Fax | 772-562-9436
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Provider Business Mailing Address
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Address Line | 2686 US HIGHWAY 1
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City | VERO BEACH
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State | FL
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Zip | 32960-5080
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Country | US
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Telephone | 772-562-9045
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Fax | 772-562-9436
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Authorized Official
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Title or Position | OWNER / OPERATOR
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Name | ALTHEA POWELL
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Credential | C.PED, L.PED
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Telephone | 772-562-9045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | PED 78
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License Number State | FL
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