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General NPI Number Information
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NPI Number | 1588087001
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Entity Type | Organization
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Legal Business Name | GULF COAST ORTHOTICS & PROSTHETICS CENTER, LLC
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Dates
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Enumeration Date | 02/04/2014
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Last Update Date | 03/21/2014
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Provider Practice Location Address
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Address Line | 21300 GERTRUDE AVE
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-5002
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Country | US
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Telephone | 941-408-6246
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Fax | 941-249-8956
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Provider Business Mailing Address
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Address Line | 21300 GERTRUDE AVE
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-5002
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LILLIANE M RODERIQUES
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Credential |
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Telephone | 941-408-6246
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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 | POR181
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License Number State | FL
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