Provider Demographics
NPI:1255451621
Name:M-TECH ORTHOTICS INC.
Entity type:Organization
Organization Name:M-TECH ORTHOTICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRAVES-BOYNTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-761-5869
Mailing Address - Street 1:7718 DEBEAUBIEN DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-8126
Mailing Address - Country:US
Mailing Address - Phone:800-318-4199
Mailing Address - Fax:407-291-7456
Practice Address - Street 1:545 DELANEY AVE
Practice Address - Street 2:BLDG.1-B
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-3866
Practice Address - Country:US
Practice Address - Phone:407-761-5869
Practice Address - Fax:407-291-7456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLORF175332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1189300001Medicare ID - Type Unspecified