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General NPI Number Information
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NPI Number | 1548731433
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Entity Type | Organization
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Legal Business Name | INTERCOASTAL ORTHOTICS LLC
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Dates
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Enumeration Date | 12/17/2018
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Last Update Date | 12/27/2018
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Provider Practice Location Address
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Address Line | 885 SE 6TH AVE STE E
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City | DELRAY BEACH
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State | FL
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Zip | 33483-5184
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Country | US
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Telephone | 561-332-3295
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Fax |
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Provider Business Mailing Address
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Address Line | 851 SE 6TH AVE STE E
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City | DELRAY BEACH
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State | FL
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Zip | 33483-5276
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Country | US
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Telephone | 561-332-3295
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WILLIAM NOVACK
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Credential |
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Telephone | 407-367-9149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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