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General NPI Number Information
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NPI Number | 1598989402
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Entity Type | Organization
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Legal Business Name | ORTHOSPORTS LLC
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 11/12/2008
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Provider Practice Location Address
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Address Line | 3251 MCMULLEN BOOTH RD SUITE 201
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City | CLEARWATER
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State | FL
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Zip | 33761-2022
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Country | US
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Telephone | 727-725-6231
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Fax | 727-791-4563
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Provider Business Mailing Address
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Address Line | 3251 MCMULLEN BOOTH RD SUITE 201
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City | CLEARWATER
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State | FL
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Zip | 33761-2022
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Country | US
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Telephone | 727-725-6231
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Fax | 727-791-4563
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Authorized Official
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Title or Position | MEMBER MANAGER
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Name | BRIAN C OLIVER
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Credential | MD
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Telephone | 727-725-6231
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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 | ME57739
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License Number State | FL
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