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General NPI Number Information
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NPI Number | 1508449257
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Entity Type | Organization
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Legal Business Name | MAHNKE'S ORTHOTICS & PROSTHETICS OF DEERFIELD, INC
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Dates
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Enumeration Date | 04/30/2021
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Last Update Date | 04/30/2021
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Provider Practice Location Address
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Address Line | 1326 S RIDGEWOOD AVE STE 1516
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-7218
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Country | US
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Telephone | 386-280-7020
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Fax | 786-536-5693
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Provider Business Mailing Address
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Address Line | 4990 SW 72ND AVE STE 107
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City | MIAMI
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State | FL
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Zip | 33155-5524
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Country | US
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Telephone | 786-360-5514
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Fax | 786-536-5693
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Authorized Official
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Title or Position | PRESIDENT
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Name | SILVIO ANDRES MARTINEZ
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Credential | LPO, CPO
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Telephone | 786-360-5514
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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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