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General NPI Number Information
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NPI Number | 1750362471
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Entity Type | Organization
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Legal Business Name | FAATZ, INC
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Dates
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Enumeration Date | 11/09/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 210 E CENTRAL AVE
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City | WINTER HAVEN
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State | FL
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Zip | 33880-6311
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Country | US
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Telephone | 863-291-3000
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Fax | 863-293-7004
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Provider Business Mailing Address
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Address Line | 210 E CENTRAL AVE
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City | WINTER HAVEN
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State | FL
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Zip | 33880-6311
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Country | US
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Telephone | 863-291-3000
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Fax | 863-293-7004
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MR. BRUCE M WOOLEY
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Credential | PROSTHETIST
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Telephone | 863-682-1040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | PRO36,PRO60,ORT91
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License Number State | FL
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