Organization
SUN STATE PROSTHETICS INC
Active
Parent organization
SUN STATE PROSTHETICS INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
SUN STATE PROSTHETICS INC
Authorized official
CHARLES F GANO LCP (OWNER)
(407) 629-2866
Entity
Organization
Contact information
Practice address
756 BERKSHIRE RD, DAYTONA BEACH, FL 32114-1602
(407) 629-2866
(407) 629-4277
Mailing address
1444 W FAIRBANKS AVE, WINTER PARK, FL 32789-4806
(407) 629-2866
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
PRO 12
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0662480002
PTAN
FL
Enumeration date
03/26/2007
Last updated
09/15/2016
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