# PSL ORTHOTICS, LLC

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

## Provider details

- **NPI number:** 1396349312
- **Authorized official:** LILIYA HERETSUN-ROUSSONICOLOS (OWNER)
- **Authorized official phone:** (772) 207-6266

## Contact information

- **Practice address:** 679 SW WHITMORE DR STE 2, PORT ST LUCIE, FL 34984-3567
- **Practice address phone:** (772) 249-0141
- **Practice address fax:** (772) 249-0445
- **Mailing address:** 679 SW WHITMORE DR STE 2, PORT ST LUCIE, FL 34984-3567
- **Mailing address phone:** (772) 207-6266

## Taxonomy

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

## Other

- **Enumeration date:** 11/30/2020
- **Last updated:** 12/04/2020