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General NPI Number Information
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NPI Number | 1902030109
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Entity Type | Organization
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Legal Business Name | NEW LIFE BRACE & LIMB, LLC
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Dates
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Enumeration Date | 05/04/2009
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Last Update Date | 10/05/2010
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Provider Practice Location Address
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Address Line | 1 MEDIC LANE
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City | ALVIN
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State | TX
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Zip | 77511
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Country | US
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Telephone | 281-331-4500
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Fax | 281-331-4502
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Provider Business Mailing Address
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Address Line | 250 BLOSSOM ST. #200
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City | WEBSTER
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State | TX
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Zip | 77598
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Country | US
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Telephone | 281-316-5805
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Fax | 281-316-5970
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Authorized Official
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Title or Position | OWNER
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Name | MR. RUSSELL LYNN BOONE
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Credential |
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Telephone | 281-316-5805
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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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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 101307
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License Number State | TX
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