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General NPI Number Information
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NPI Number | 1659426583
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Entity Type | Organization
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Legal Business Name | FLORIDA PEDORTHICS INCORPORATED
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 12/20/2016
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Provider Practice Location Address
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Address Line | 1403 W BOYNTON BEACH BLVD SUITE 14-15
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City | BOYNTON BEACH
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State | FL
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Zip | 33426
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Country | US
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Telephone | 561-734-0032
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Fax | 561-734-5758
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Provider Business Mailing Address
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Address Line | 1403 W BOYNTON BEACH BLVD SUITE 14-15
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City | BOYNTON BEACH
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State | FL
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Zip | 33426
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Country | US
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Telephone | 561-734-0032
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Fax | 561-734-5758
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSEPH F LAROCCA
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Credential | CPED
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Telephone | 561-734-0032
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | PED20
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License Number State | FL
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