Provider Demographics
NPI:1306838792
Name:SONLIFE PROSTHETICS & ORTHOTICS, INC
Entity Type:Organization
Organization Name:SONLIFE PROSTHETICS & ORTHOTICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-596-2257
Mailing Address - Street 1:2024 HIGHWAY 44 W
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34453-3804
Mailing Address - Country:US
Mailing Address - Phone:352-344-8200
Mailing Address - Fax:352-344-5997
Practice Address - Street 1:2024 HIGHWAY 44 W
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34453-3804
Practice Address - Country:US
Practice Address - Phone:352-344-8200
Practice Address - Fax:352-344-5997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR 16335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL027898000Medicaid
FL027898000Medicaid