Organization
ABOUT YOU
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY WAYNE SOKOL (OWNER)
(801) 891-1475
Entity
Organization
Contact information
Practice address
3401 HENDERSON BLVD, SUITE A, TAMPA, FL 33609-3989
(813) 876-2727
(813) 876-2725
Mailing address
3401 HENDERSON BLVD STE A, TAMPA, FL 33609-3988
(813) 876-2727
(480) 907-3092
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
000000000
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004431
—
AZ
05
—
019334400
—
FL
Enumeration date
10/25/2012
Last updated
03/28/2023
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