Provider Demographics
NPI:1194978833
Name:FREEDOM ORTHOTICS & PROSTHETICS
Entity type:Organization
Organization Name:FREEDOM ORTHOTICS & PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:STUART LEE
Authorized Official - Last Name:SHEEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPO, CO
Authorized Official - Phone:281-580-8228
Mailing Address - Street 1:3185 CALDER ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1410
Mailing Address - Country:US
Mailing Address - Phone:409-839-8888
Mailing Address - Fax:409-839-8889
Practice Address - Street 1:3185 CALDER ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1410
Practice Address - Country:US
Practice Address - Phone:409-839-8888
Practice Address - Fax:409-839-8889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224P00000X
TX1335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty