=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750100152
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FREEDOM ORTHOPAEDICS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2024
-----------------------------------------------------
Last Update Date | 10/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9960 CENTRAL PARK BLVD N STE 225
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33428-1705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-695-6284
-----------------------------------------------------
Fax | 561-710-2866
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4280 SAINT CHARLES WAY
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33434-5359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-695-6284
-----------------------------------------------------
Fax | 561-710-2866
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | MS. JESSICA FRITZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-695-6284
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------