# SOUTHEAST ORTHOTICS INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033130182
- **Authorized official:** BRENT E SQUIRES (OWNER)
- **Authorized official phone:** (813) 986-9657

## Contact information

- **Practice address:** 17429 BRIDGE HILL CT, SUITE D, TAMPA, FL 33647-3467
- **Practice address phone:** (813) 615-2277
- **Practice address fax:** (813) 632-3377
- **Mailing address:** 10506 CORY LAKE DR, TAMPA, FL 33647-2710
- **Mailing address phone:** (813) 986-9657
- **Mailing address fax:** (813) 982-1034

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |

## Other

- **Enumeration date:** 07/22/2006
- **Last updated:** 07/05/2011