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General NPI Number Information
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NPI Number | 1992075295
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES - SOUTHEAST, LLC
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Dates
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Enumeration Date | 01/04/2012
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 950 W FARIS RD
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City | GREENVILLE
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State | SC
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Zip | 29605-4255
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Country | US
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Telephone | 864-255-7951
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Fax | 864-255-8751
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Provider Business Mailing Address
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Address Line | PO BOX 947109
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City | ATLANTA
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State | GA
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Zip | 30394-7109
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Country | US
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Telephone | 864-255-8761
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Fax | 864-255-8751
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Authorized Official
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Title or Position | MANAGER
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Name | MR. FRANK CARUSO
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Credential |
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Telephone | 864-255-8761
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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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