MEDICARE: BACK BRACES PLUS, 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1528571122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK BRACES PLUS, INC

Provider Business Mailing Address
First Line	:	9365 US HIGHWAY 19 N STE A
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33782-5400
Country	:	US
Telephone Number	:	727-685-5904
Fax Number	:	727-685-5953

Provider Business Practice Location Address
First Line	:	9365 US HIGHWAY 19 N STE A
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33782-5400
Country	:	US
Telephone Number	:	727-685-5904
Fax Number	:	727-685-5953

Authorized Official
Title or Position	:	OWNER
Name	:	DANNY JOEY HARVEY II
Credential	:
Telephone Number	:	727-685-5904

Provider Enumeration Date	:	11/06/2017
Last Update Date	:	01/10/2018

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