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NPI Code Detail

MEDICARE: PENSACOLA ORTHOTIC & PROSTHETIC SPECIALTIES, INC

MEDICARE: PENSACOLA ORTHOTIC & PROSTHETIC SPECIALTIES, 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
1335E00000XProsthetic/Orthotic SupplierORT17FL

General Provider Information

NPI Number : 1972812014
Entity Type Code : Organization
Provider Name (Legal Business Name) : PENSACOLA ORTHOTIC & PROSTHETIC SPECIALTIES, INC
Provider Business Mailing Address
First Line : 5855 CREEK STATION DR
Second Line :
City : PENSACOLA
State : FL
Zip : 32504-8626
Country : US
Telephone Number : 850-478-7676
Fax Number : 850-478-7699
Provider Business Practice Location Address
First Line : 5855 CREEK STATION DR
Second Line :
City : PENSACOLA
State : FL
Zip : 32504-8626
Country : US
Telephone Number : 850-478-7676
Fax Number : 850-478-7699
Authorized Official
Title or Position : PRESIDENT
Name : THOMAS D DECKERT
Credential : C.O.
Telephone Number : 850-478-7676
Provider Enumeration Date : 10/06/2010
Last Update Date : 12/03/2010

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Directions to “PENSACOLA ORTHOTIC & PROSTHETIC SPECIALTIES, INC ” Practice Location

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