MEDICARE: FLORIDA PEDORTHICS INCORPORATED

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)	PED20	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659426583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA PEDORTHICS INCORPORATED

Provider Business Mailing Address
First Line	:	1403 W BOYNTON BEACH BLVD
Second Line	:	SUITE 14-15
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426
Country	:	US
Telephone Number	:	561-734-0032
Fax Number	:	561-734-5758

Provider Business Practice Location Address
First Line	:	1403 W BOYNTON BEACH BLVD
Second Line	:	SUITE 14-15
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426
Country	:	US
Telephone Number	:	561-734-0032
Fax Number	:	561-734-5758

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSEPH F LAROCCA
Credential	:	CPED
Telephone Number	:	561-734-0032

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	12/20/2016

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Directions to “FLORIDA PEDORTHICS INCORPORATED ” Practice Location

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