Provider Demographics
NPI:1831126275
Name:FLORIDA BRACE & LIMB, INC.
Entity Type:Organization
Organization Name:FLORIDA BRACE & LIMB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:YASOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-786-0880
Mailing Address - Street 1:2445 TAMPA RD STE H
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-5849
Mailing Address - Country:US
Mailing Address - Phone:727-786-0880
Mailing Address - Fax:727-786-0882
Practice Address - Street 1:2445 TAMPA RD STE H
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-5849
Practice Address - Country:US
Practice Address - Phone:727-786-0880
Practice Address - Fax:727-786-0882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR57222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9520694Medicaid
1030710001Medicare NSC