Organization
SUN STATE PROSTHETICS INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES FREDERICK GANO L.C.P. (OWNER)
(407) 629-2866
Entity
Organization
Contact information
Practice address
1444 W FAIRBANKS AVE, WINTER PARK, FL 32789-4806
(407) 629-2866
(407) 629-4277
Mailing address
1444 W FAIRBANKS AVE, WINTER PARK, FL 32789-4806
(407) 629-2866
(407) 629-4277
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
PRO 12
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0662480001
PTAN
FL
Enumeration date
07/16/2006
Last updated
09/15/2016
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