MEDICARE: BRACE YOURSELF ORTHOTICS & PROSTETICS, 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	222Z00000X	Orthotist	C52232	AL

General Provider Information

NPI Number	:	1538641774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRACE YOURSELF ORTHOTICS & PROSTETICS, LLC.

Provider Business Mailing Address
First Line	:	181 W VALLEY AVE
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-3691
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	181 W VALLEY AVE
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-3691
Country	:	US
Telephone Number	:	205-919-3900
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANTWAUN BURROUGHS
Credential	:
Telephone Number	:	205-919-3900

Provider Enumeration Date	:	09/04/2018
Last Update Date	:	06/11/2019

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