Organization
SMART FORM INC
Active
Other names
Smart Foam Corset Shop
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAURIE J CHURMA BOC CERTIFIED (GENERAL MANAGER)
(412) 281-9913
Entity
Organization
Contact information
Practice address
100 5TH AVE, SUITE 804, PITTSBURGH, PA 15222-1821
(412) 281-9913
(412) 281-8074
Mailing address
100 5TH AVE, SUITE 804, PITTSBURGH, PA 15222-1821
(412) 281-9913
(412) 281-8074
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016096020001
—
PA
Enumeration date
08/23/2005
Last updated
08/22/2020
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