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General NPI Number Information
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NPI Number | 1841482460
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Entity Type | Organization
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Legal Business Name | FREEDOM PROSTHETICS LLC
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Dates
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Enumeration Date | 08/16/2007
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Last Update Date | 10/14/2019
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Provider Practice Location Address
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Address Line | 9354 FLORIDA BLVD
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City | WALKER
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State | LA
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Zip | 70785-7104
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Country | US
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Telephone | 225-665-0323
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Fax | 225-665-0319
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Provider Business Mailing Address
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Address Line | 9354 FLORIDA BLVD
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City | WALKER
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State | LA
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Zip | 70785-7104
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Country | US
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Telephone | 225-665-0323
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Fax | 225-665-0319
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID RICKY BRYAN SR.
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Credential | BOCP
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Telephone | 225-665-0323
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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 |
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License Number State |
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