MEDICARE: NEW LIFE BRACE AND LIMB, LLC

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

General Provider Information

NPI Number	:	1992934764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW LIFE BRACE AND LIMB, LLC

Provider Business Mailing Address
First Line	:	250 BLOSSOM ST STE 200
Second Line	:
City	:	WEBSTER
State	:	TX
Zip	:	77598-4243
Country	:	US
Telephone Number	:	281-316-5805
Fax Number	:	281-316-5970

Provider Business Practice Location Address
First Line	:	7525 SOUTH FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77021-5928
Country	:	US
Telephone Number	:	713-440-7000
Fax Number	:	713-440-7002

Authorized Official
Title or Position	:	OWNER
Name	:	MR. RUSSELL BOONE
Credential	:
Telephone Number	:	713-440-7000

Provider Enumeration Date	:	07/14/2009
Last Update Date	:	09/26/2016

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Directions to “NEW LIFE BRACE AND LIMB, LLC ” Practice Location

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