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General NPI Number Information
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NPI Number | 1467597450
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Entity Type | Organization
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Legal Business Name | BREVARD PROSTHETICS & ORTHOTICS, INC.
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 08/23/2024
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Provider Practice Location Address
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Address Line | 3040 N WICKHAM RD STE 14
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City | MELBOURNE
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State | FL
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Zip | 32935-2305
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Country | US
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Telephone | 321-733-7778
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Fax | 321-638-4559
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Provider Business Mailing Address
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Address Line | 3803 E LINCOLN HWY
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City | MERRILLVILLE
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State | IN
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Zip | 46410-5809
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Country | US
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Telephone | 219-648-2644
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Fax | 219-228-8510
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Authorized Official
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Title or Position | CONTRACTING MANAGER
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Name | MR. LAURA ALLEN
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Credential |
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Telephone | 336-339-9671
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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 |
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