MEDICARE: SPORTS BRACING USA, 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	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1659370294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPORTS BRACING USA, INC.

Provider Business Mailing Address
First Line	:	3162 NEWBERRY DR
Second Line	:	SUITE B
City	:	SAN JOSE
State	:	CA
Zip	:	95118-1500
Country	:	US
Telephone Number	:	408-978-1114
Fax Number	:	408-978-1166

Provider Business Practice Location Address
First Line	:	3162 NEWBERRY DR
Second Line	:	SUITE B
City	:	SAN JOSE
State	:	CA
Zip	:	95118-1500
Country	:	US
Telephone Number	:	408-978-1114
Fax Number	:	408-978-1166

Authorized Official
Title or Position	:	OWNER
Name	:	MR. GARY L. BROWN
Credential	:
Telephone Number	:	408-978-1114

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	08/22/2020

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