Provider Demographics
NPI:1184669939
Name:SPECIALTY BRACE & LIMB, INC.
Entity Type:Organization
Organization Name:SPECIALTY BRACE & LIMB, INC.
Other - Org Name:SPECIALTY BRACE & LIMB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-493-8288
Mailing Address - Street 1:1222 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4918
Mailing Address - Country:US
Mailing Address - Phone:407-740-7772
Mailing Address - Fax:407-539-1791
Practice Address - Street 1:1222 ORANGE AVE
Practice Address - Street 2:STE B
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4918
Practice Address - Country:US
Practice Address - Phone:407-740-7772
Practice Address - Fax:407-539-1791
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HANGER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-17
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL030823400Medicaid
FL030823400Medicaid