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General NPI Number Information
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NPI Number | 1508586694
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Entity Type | Organization
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Legal Business Name | CUSTOM ARTIFICIAL LIMB AND BRACE, INC.
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Dates
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Enumeration Date | 08/30/2022
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Last Update Date | 08/30/2022
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Provider Practice Location Address
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Address Line | 491 E BRUCETON RD
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City | PLEASANT HILLS
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State | PA
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Zip | 15236-5525
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Country | US
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Telephone | 724-654-3991
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Fax |
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Provider Business Mailing Address
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Address Line | 491 E BRUCETON RD
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City | PLEASANT HILLS
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State | PA
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Zip | 15236-5525
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Country | US
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Telephone | 724-654-3991
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | BOBBY COLES
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Credential |
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Telephone | 724-654-3991
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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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