MEDICARE: MARTIN PROSTHETICS AND ORTHOTICS 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

General Provider Information

NPI Number	:	1538491410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTIN PROSTHETICS AND ORTHOTICS INC

Provider Business Mailing Address
First Line	:	5950 HIGH ST
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4149
Country	:	US
Telephone Number	:	727-845-1995
Fax Number	:	727-845-1994

Provider Business Practice Location Address
First Line	:	5950 HIGH ST
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4149
Country	:	US
Telephone Number	:	727-845-1995
Fax Number	:	727-845-1994

Authorized Official
Title or Position	:	OWNER
Name	:	GERALD LEE MARTIN JR.
Credential	:	LPO, CPO, FAAOP
Telephone Number	:	727-845-1995

Provider Enumeration Date	:	02/03/2010
Last Update Date	:	02/03/2010

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