Provider Demographics
NPI:1912406950
Name:PROSTHETICS CLINIC OF FLORIDA, LLC
Entity type:Organization
Organization Name:PROSTHETICS CLINIC OF FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SWIERZBINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:352-436-1688
Mailing Address - Street 1:5651 GULF DR STE 4
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4019
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5651 GULF DR STE 4
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4019
Practice Address - Country:US
Practice Address - Phone:352-436-1688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-05
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR240222Z00000X, 224P00000X
261QA0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
No261QA0900XAmbulatory Health Care FacilitiesClinic/CenterAmputeeGroup - Multi-Specialty