MEDICARE: WOUND CARE PROS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM1300X	Multi-Specialty Clinic/Center
2	251E00000X	Home Health Agency
3	253Z00000X	In Home Supportive Care Agency
4	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1710465679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOUND CARE PROS LLC

Provider Business Mailing Address
First Line	:	1180 SPRING CENTRE SOUTH BLVD STE 225
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-1991
Country	:	US
Telephone Number	:	407-212-8431
Fax Number	:	407-386-7878

Provider Business Practice Location Address
First Line	:	1180 SPRING CENTRE SOUTH BLVD STE 225
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-1991
Country	:	US
Telephone Number	:	407-212-8431
Fax Number	:	407-386-7878

Authorized Official
Title or Position	:	CO-OWNER
Name	:	DUSTIN MOURA
Credential	:	PTA
Telephone Number	:	407-388-8866

Provider Enumeration Date	:	08/02/2018
Last Update Date	:	02/10/2023

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Directions to “WOUND CARE PROS LLC ” Practice Location

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