Provider Demographics
NPI:1205968013
Name:ST PETERSBURG LIMB AND BRACE, INC.
Entity type:Organization
Organization Name:ST PETERSBURG LIMB AND BRACE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:HOCZ
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:727-321-3900
Mailing Address - Street 1:1001 37TH ST N STE B
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-6010
Mailing Address - Country:US
Mailing Address - Phone:727-321-3900
Mailing Address - Fax:727-323-9516
Practice Address - Street 1:1001 37TH ST N STE B
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-6010
Practice Address - Country:US
Practice Address - Phone:727-321-3900
Practice Address - Fax:727-323-9516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL027598100Medicaid
FL027598100Medicaid