MEDICARE: ORTHOQUIP, 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	ORF12	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ORF13	OTHER	FL	ORTHOTIC FITTER LICENSE

General Provider Information

NPI Number	:	1952614968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOQUIP, INC.

Provider Business Mailing Address
First Line	:	4710 NE 25TH AVE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-4811
Country	:	US
Telephone Number	:	954-650-2263
Fax Number	:

Provider Business Practice Location Address
First Line	:	4022 N OCEAN BLVD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-6420
Country	:	US
Telephone Number	:	954-650-2263
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. DEBRA GROENEVELD
Credential	:
Telephone Number	:	954-650-2263

Provider Enumeration Date	:	07/19/2010
Last Update Date	:	07/19/2010

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Directions to “ORTHOQUIP, INC. ” Practice Location

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