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General NPI Number Information
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NPI Number | 1558328393
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Entity Type | Organization
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Legal Business Name | COASTAL PROSTHETICS & ORTHOTICS, LLC
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 06/26/2024
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Provider Practice Location Address
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Address Line | 6330 N. CENTER DR. BLDG 13. STE 125
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City | NORFOLK
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State | VA
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Zip | 23502-4009
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Country | US
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Telephone | 757-892-5300
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Fax | 757-892-5303
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Provider Business Mailing Address
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Address Line | 433 NETWORK STA
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City | CHESAPEAKE
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State | VA
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Zip | 23320-3851
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Country | US
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Telephone | 757-892-5300
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Fax | 757-892-5303
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Authorized Official
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Title or Position | PRESIDENT, CPO
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Name | STEPHEN A SIVERD
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Credential | CPO
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Telephone | 757-892-5300
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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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