Provider Demographics
NPI:1619509395
Name:SKY ORTHOTICS & PROSTHETICS LLC
Entity Type:Organization
Organization Name:SKY ORTHOTICS & PROSTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWMYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-759-5462
Mailing Address - Street 1:1009 MAITLAND CENTER COMMONS BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7270
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3233 SW 33RD RD STE 201
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-8469
Practice Address - Country:US
Practice Address - Phone:407-698-7103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SKY ORTHOTICS & PROSTHETICS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier