Provider Demographics
NPI:1609929082
Name:GABRIEL HURST PROSTHETICS, LLC
Entity Type:Organization
Organization Name:GABRIEL HURST PROSTHETICS, LLC
Other - Org Name:ALL ABOUT PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HURST
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:727-388-9744
Mailing Address - Street 1:3801 PARK ST N
Mailing Address - Street 2:3
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-4078
Mailing Address - Country:US
Mailing Address - Phone:727-388-9744
Mailing Address - Fax:
Practice Address - Street 1:3801 PARK ST N
Practice Address - Street 2:3
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-4078
Practice Address - Country:US
Practice Address - Phone:727-388-9744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR127335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier