Provider Demographics
NPI:1528287315
Name:PROSTHETIC & ORTHOTIC SERVICES, INC.
Entity type:Organization
Organization Name:PROSTHETIC & ORTHOTIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:GALLO
Authorized Official - Suffix:
Authorized Official - Credentials:LPO
Authorized Official - Phone:941-486-4200
Mailing Address - Street 1:PO BOX 1521
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34284
Mailing Address - Country:US
Mailing Address - Phone:941-486-4200
Mailing Address - Fax:941-486-9300
Practice Address - Street 1:256 NOKOMIS AVE S
Practice Address - Street 2:STE 4
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2357
Practice Address - Country:US
Practice Address - Phone:941-486-4200
Practice Address - Fax:941-486-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR 6335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82649OtherNORTHWOOD-NPN
FLM2769OtherBC-BS
FLM2769OtherBC-BS