Provider Demographics
NPI:1477626455
Name:FRACTURE BRACING
Entity Type:Organization
Organization Name:FRACTURE BRACING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUMBORE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:215-331-5959
Mailing Address - Street 1:9140 ACADEMY RD STE B
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-2853
Mailing Address - Country:US
Mailing Address - Phone:215-331-9777
Mailing Address - Fax:215-331-1393
Practice Address - Street 1:9140 ACADEMY RD STE B
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2853
Practice Address - Country:US
Practice Address - Phone:215-331-9777
Practice Address - Fax:215-331-1393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA187706332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0210080001Medicare ID - Type Unspecified