MEDICARE: ADVANCED MEDICAL BRACING LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1447727508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED MEDICAL BRACING LLC

Provider Business Mailing Address
First Line	:	10191 W SAMPLE RD STE 212
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-3959
Country	:	US
Telephone Number	:	754-529-8191
Fax Number	:

Provider Business Practice Location Address
First Line	:	10191 W SAMPLE RD STE 212
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-3959
Country	:	US
Telephone Number	:	754-529-8191
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LOUTRICIA MORGAN
Credential	:
Telephone Number	:	754-529-8191

Provider Enumeration Date	:	10/26/2018
Last Update Date	:	04/01/2020

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