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General NPI Number Information
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NPI Number | 1508674631
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Entity Type | Organization
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Legal Business Name | ORTHOPAEDIC TOI LLC
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Dates
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Enumeration Date | 12/20/2024
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 5438 PINE LILLY DR
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City | SAINT CLOUD
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State | FL
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Zip | 34771-0120
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Country | US
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Telephone | 407-751-0223
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 701795
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City | SAINT CLOUD
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State | FL
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Zip | 34770-1795
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Country | US
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Telephone | 407-751-0223
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | WILLIAM ALEXANDER RODRIGUEZ LOPEZ
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Credential |
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Telephone | 407-751-0223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225000000X
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Taxonomy Name | Orthotic Fitter
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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