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General NPI Number Information
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NPI Number | 1386611978
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Entity Type | Organization
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Legal Business Name | ADVANCE PROSTHETICS AND ORTHOTICS, INC.
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Dates
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Enumeration Date | 03/02/2006
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Last Update Date | 07/01/2021
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Provider Practice Location Address
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Address Line | 4537 EMERSON ST
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City | JACKSONVILLE
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State | FL
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Zip | 32207-4918
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Country | US
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Telephone | 904-858-1515
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Fax |
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Provider Business Mailing Address
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Address Line | 4537 EMERSON ST
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City | JACKSONVILLE
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State | FL
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Zip | 32207-4918
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Country | US
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Telephone | 904-858-1515
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL DEAN RICHARD
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Credential | C.P.O.
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Telephone | 904-858-1515
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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 | POR67
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License Number State | FL
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