Provider Demographics
NPI:1972812014
Name:PENSACOLA ORTHOTIC & PROSTHETIC SPECIALTIES, INC
Entity type:Organization
Organization Name:PENSACOLA ORTHOTIC & PROSTHETIC SPECIALTIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:DECKERT
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:850-478-7676
Mailing Address - Street 1:5855 CREEK STATION DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8626
Mailing Address - Country:US
Mailing Address - Phone:850-478-7676
Mailing Address - Fax:850-478-7699
Practice Address - Street 1:5855 CREEK STATION DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8626
Practice Address - Country:US
Practice Address - Phone:850-478-7676
Practice Address - Fax:850-478-7699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-06
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLORT17335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier