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General NPI Number Information
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NPI Number | 1730639204
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Entity Type | Organization
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Legal Business Name | TEQUESTA BRACING
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Dates
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Enumeration Date | 10/09/2016
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Last Update Date | 05/16/2018
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Provider Practice Location Address
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Address Line | 151 E 1ST ST STE 141
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City | POWELL
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State | WY
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Zip | 82435-2701
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Country | US
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Telephone | 307-271-3030
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Fax | 307-333-0082
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Provider Business Mailing Address
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Address Line | 151 E 1ST ST STE 141
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City | POWELL
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State | WY
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Zip | 82435-2701
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Country | US
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Telephone | 307-271-3030
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Fax | 307-333-0082
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Authorized Official
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Title or Position | CEO/DIRECTOR
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Name | IBETH BUITRAGO
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Credential |
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Telephone | 307-271-3030
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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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