Provider Demographics
NPI:1568469344
Name:THE BRACE SHOP, INC.
Entity Type:Organization
Organization Name:THE BRACE SHOP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CERTIFIED ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:ABC/BOCO CERTIFIED
Authorized Official - Phone:410-265-9292
Mailing Address - Street 1:1718 BELMONT AVE
Mailing Address - Street 2:SUITE I
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2552
Mailing Address - Country:US
Mailing Address - Phone:410-265-9292
Mailing Address - Fax:410-265-9295
Practice Address - Street 1:1718 BELMONT AVE
Practice Address - Street 2:SUITE I
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-2552
Practice Address - Country:US
Practice Address - Phone:410-265-9292
Practice Address - Fax:410-265-9295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03002297332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0474350001Medicare ID - Type UnspecifiedDURABLE MEDICAL EQUIPMENT