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General NPI Number Information
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NPI Number | 1861534216
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Entity Type | Organization
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Legal Business Name | MANATEE PROSTHETICS & ORTHOTICS
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 12/15/2016
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Provider Practice Location Address
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Address Line | 535 8TH ST W
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City | BRADENTON
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State | FL
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Zip | 34205-8530
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Country | US
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Telephone | 941-747-5407
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Fax | 941-747-4914
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Provider Business Mailing Address
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Address Line | 535 8TH ST W
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City | BRADENTON
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State | FL
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Zip | 34205-8530
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Country | US
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Telephone | 941-747-5407
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Fax | 941-747-4914
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN D HAGMAN
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Credential | LPO,CP
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Telephone | 941-747-5407
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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 | POR131
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License Number State | FL
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