Provider Demographics
NPI:1073924940
Name:GORALNIK, B. SCOTT (ORTHOTIC FITTER)
Entity Type:Individual
Prefix:
First Name:B.
Middle Name:SCOTT
Last Name:GORALNIK
Suffix:
Gender:M
Credentials:ORTHOTIC FITTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 N NOVA RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4447
Mailing Address - Country:US
Mailing Address - Phone:386-310-4359
Mailing Address - Fax:386-310-4394
Practice Address - Street 1:533 N NOVA RD
Practice Address - Street 2:SUITE 109
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-4447
Practice Address - Country:US
Practice Address - Phone:386-310-4359
Practice Address - Fax:386-310-4394
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter