MEDICARE: FAATZ, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier	PRO36,PRO60,ORT91,OR	FL

General Provider Information

NPI Number	:	1073519831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAATZ, INC.

Provider Business Mailing Address
First Line	:	2606 LAKELAND HILLS BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-2218
Country	:	US
Telephone Number	:	863-682-1040
Fax Number	:

Provider Business Practice Location Address
First Line	:	2606 LAKELAND HILLS BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-2218
Country	:	US
Telephone Number	:	863-682-1040
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MR. BRUCE M WOOLEY
Credential	:	CPO, LICENSED PROS
Telephone Number	:	863-682-1040

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	08/22/2020

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Directions to “FAATZ, INC. ” Practice Location

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