Basic Information
| Provider Information | |||||||||
| NPI: | 1508336777 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | USA ORTHOTICS PROSTHETICS & ASSOCIATES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 203 S. CLYDE AVENUE | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079945596 | ||||||||
| FaxNumber: | 4072864515 | ||||||||
| Practice Location | |||||||||
| Address1: | 932 E OSCEOLA PKWY | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347441615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079945596 | ||||||||
| FaxNumber: | 4072864515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2018 | ||||||||
| LastUpdateDate: | 01/28/2019 | ||||||||
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| AuthorizedOfficialLastName: | COLON | ||||||||
| AuthorizedOfficialFirstName: | CHARLENE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4079945596 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | USA ORTHODICS PROSTHESICS & ASSOCIATE INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 335E00000X | Y | Suppliers | Prosthetic/Orthotic Supplier |
No ID Information.