Provider Demographics
NPI:1184445587
Name:TREASURE COAST PROSTHETIC & ORTHOTIC SERVICES
Entity type:Organization
Organization Name:TREASURE COAST PROSTHETIC & ORTHOTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:W
Authorized Official - Last Name:WERNER
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:772-567-5200
Mailing Address - Street 1:1645 20TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-3565
Mailing Address - Country:US
Mailing Address - Phone:772-567-5200
Mailing Address - Fax:772-567-0160
Practice Address - Street 1:1405 VALENTINE ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3129
Practice Address - Country:US
Practice Address - Phone:772-567-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier