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General NPI Number Information
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NPI Number | 1881095479
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Entity Type | Organization
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Legal Business Name | ORTHO FLORIDA, LLC
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Dates
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Enumeration Date | 09/15/2014
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Last Update Date | 10/02/2015
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Provider Practice Location Address
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Address Line | 4705 N FEDERAL HWY
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City | BOCA RATON
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State | FL
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Zip | 33431-4953
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Country | US
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Telephone | 561-405-9610
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Fax |
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Provider Business Mailing Address
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Address Line | 751 PARK OF COMMERCE DR STE 112
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City | BOCA RATON
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State | FL
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Zip | 33487-3626
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Country | US
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Telephone | 561-300-1792
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Fax |
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Authorized Official
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Title or Position | COO
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Name | DANE TRASK
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Credential |
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Telephone | 813-787-1128
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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