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General NPI Number Information
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NPI Number | 1376830273
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Entity Type | Organization
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Legal Business Name | NORTH CAROLINA ORTHOTICS & PROSTHETICS OF ROCKY MOUNT, INC
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Dates
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Enumeration Date | 06/30/2011
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Last Update Date | 08/14/2018
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Provider Practice Location Address
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Address Line | 3721 SUNSET AVE
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-3327
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Country | US
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Telephone | 252-210-3472
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Fax | 252-210-3473
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Provider Business Mailing Address
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Address Line | 2717 LEIGHTON RIDGE DR STE100
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City | WAKE FOREST
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State | NC
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Zip | 27587-5987
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Country | US
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Telephone | 252-535-0077
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Fax | 252-535-0078
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Authorized Official
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Title or Position | OWNER
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Name | CINDY JOHNCOUR
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Credential |
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Telephone | 919-556-3402
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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 |
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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