Provider Demographics
NPI:1790781482
Name:GARRISON'S ORTHOTHIC & PROSTHETIC
Entity Type:Organization
Organization Name:GARRISON'S ORTHOTHIC & PROSTHETIC
Other - Org Name:GARRISON'S ORTHOTIC & PROSTHETIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:CP, LP
Authorized Official - Phone:954-960-8747
Mailing Address - Street 1:1531 E ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-6748
Mailing Address - Country:US
Mailing Address - Phone:954-960-8747
Mailing Address - Fax:305-949-5546
Practice Address - Street 1:1531 E ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-6748
Practice Address - Country:US
Practice Address - Phone:954-960-8757
Practice Address - Fax:305-949-5546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1048620001Medicare NSC