Provider Demographics
NPI:1023446895
Name:ABOUT YOU BRACE AND LIMB, LLC
Entity type:Organization
Organization Name:ABOUT YOU BRACE AND LIMB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURQUE
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:386-323-7990
Mailing Address - Street 1:1255 MASON AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-4501
Mailing Address - Country:US
Mailing Address - Phone:386-323-7990
Mailing Address - Fax:386-323-7992
Practice Address - Street 1:1255 MASON AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-4501
Practice Address - Country:US
Practice Address - Phone:386-323-7990
Practice Address - Fax:386-323-7992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLORT6335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier