Provider Demographics
NPI:1659426583
Name:FLORIDA PEDORTHICS INCORPORATED
Entity Type:Organization
Organization Name:FLORIDA PEDORTHICS INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:F
Authorized Official - Last Name:LAROCCA
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:561-734-0032
Mailing Address - Street 1:1403 W BOYNTON BEACH BLVD
Mailing Address - Street 2:SUITE 14-15
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426
Mailing Address - Country:US
Mailing Address - Phone:561-734-0032
Mailing Address - Fax:561-734-5758
Practice Address - Street 1:1403 W BOYNTON BEACH BLVD
Practice Address - Street 2:SUITE 14-15
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426
Practice Address - Country:US
Practice Address - Phone:561-734-0032
Practice Address - Fax:561-734-5758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPED20332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017110400Medicaid
1042350001Medicare NSC