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Organization
SOUTHEAST ORTHOTICS INC
Active
Organization
SOUTHEAST ORTHOTICS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENT E SQUIRES (OWNER)
(813) 986-9657
Entity
Organization
Contact information
Practice address
17429 BRIDGE HILL CT, SUITE D, TAMPA, FL 33647-3467
(813) 615-2277
(813) 632-3377
Mailing address
10506 CORY LAKE DR, TAMPA, FL 33647-2710
(813) 986-9657
(813) 982-1034
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
NULL
Other
Enumeration date
07/22/2006
Last updated
07/05/2011
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