Provider Demographics
NPI:1972989507
Name:FREESTYLE
Entity Type:Organization
Organization Name:FREESTYLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:FREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-883-3733
Mailing Address - Street 1:1907 MACARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630-4805
Mailing Address - Country:US
Mailing Address - Phone:409-883-3733
Mailing Address - Fax:409-883-3733
Practice Address - Street 1:1907 MACARTHUR DR
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-4805
Practice Address - Country:US
Practice Address - Phone:409-883-3733
Practice Address - Fax:409-883-3733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55172335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier