Organization
INTERCOASTAL ORTHOTICS & PROSTHETICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TOM HARVEY MOWERY CPO,LPO (PROSTHETIST, ORTHOTIST)
(386) 409-9432
Entity
Organization
Contact information
Practice address
1 PELICAN DR STE A, EDGEWATER, FL 32141-4254
(386) 409-9432
(386) 409-9433
Mailing address
1 PELICAN DR STE A, EDGEWATER, FL 32141-4254
(386) 409-9432
(386) 409-9433
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
POR 162
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M2714
BLUE CROSS PROVIDER #
FL
Enumeration date
04/16/2007
Last updated
08/03/2009
Update your record
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