Provider Demographics
NPI:1063608305
Name:ORTHOTICS CHOICE
Entity type:Organization
Organization Name:ORTHOTICS CHOICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:NALLEY
Authorized Official - Suffix:SR
Authorized Official - Credentials:DC
Authorized Official - Phone:407-321-0454
Mailing Address - Street 1:451 E AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-5494
Mailing Address - Country:US
Mailing Address - Phone:407-321-0454
Mailing Address - Fax:407-321-8979
Practice Address - Street 1:451 E AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-5494
Practice Address - Country:US
Practice Address - Phone:407-321-0454
Practice Address - Fax:407-321-8979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5998650001Medicare NSC