Provider Demographics
NPI:1164296448
Name:JULZ.K DYNAMIC ORTHOTICS AND PROSTHETICS CORPORATION
Entity Type:Organization
Organization Name:JULZ.K DYNAMIC ORTHOTICS AND PROSTHETICS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TYNESHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCFARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-594-2801
Mailing Address - Street 1:2351 STONEBRIDGE DR BLDG G
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5407
Mailing Address - Country:US
Mailing Address - Phone:810-820-8926
Mailing Address - Fax:810-820-8940
Practice Address - Street 1:2351 STONEBRIDGE DR BLDG G
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5407
Practice Address - Country:US
Practice Address - Phone:810-820-8926
Practice Address - Fax:810-820-8940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies