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General NPI Number Information
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NPI Number | 1871765883
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Entity Type | Organization
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Legal Business Name | ANDERSON BRACE & LIMB PLLC
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Dates
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Enumeration Date | 03/31/2008
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Last Update Date | 06/01/2017
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Provider Practice Location Address
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Address Line | 300 E PARKVIEW ST
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City | DYERSBURG
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State | TN
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Zip | 38024-3110
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Country | US
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Telephone | 731-286-6006
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Fax | 731-286-5570
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Provider Business Mailing Address
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Address Line | 300 E PARKVIEW ST
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City | DYERSBURG
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State | TN
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Zip | 38024-3110
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Country | US
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Telephone | 731-286-6006
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Fax | 731-286-5570
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Authorized Official
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Title or Position | OWNER/CERTIFIED PROSTHETIST ORTHOTI
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Name | MR. MARK WESLEY ANDERSON
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Credential | CPO
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Telephone | 731-286-6006
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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 | ORT0000000109
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | PRO0000000087
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License Number State | TN
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