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General NPI Number Information
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NPI Number | 1407904840
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Entity Type | Organization
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Legal Business Name | JSC PEDORTHICS INC.
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 100 S STATE ST STE D
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City | BUNNELL
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State | FL
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Zip | 32110-6115
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Country | US
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Telephone | 386-437-0272
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Fax | 386-437-0272
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Provider Business Mailing Address
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Address Line | 100 S STATE ST STE D
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City | BUNNELL
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State | FL
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Zip | 32110-6115
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Country | US
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Telephone | 386-437-0272
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Fax | 386-437-0272
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Authorized Official
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Title or Position | PRESIDENT
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Name | SCOTT D REEDY
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Credential | C.PED.
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Telephone | 386-437-0272
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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 53
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License Number State | FL
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