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Organization

COUNTRY COBBLER, LTD.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. MONTY K. MANTEY (PRESIDENT/OWNDER)
(910) 772-9994
Entity
Organization

Contact information

Practice address
6815 FAYETTEVILLE ROAD, #102, DURHAM, NC 27713-7081
(919) 248-0850
(919) 248-0935
Mailing address
6815 FAYETTEVILLE ROAD, #102, DURHAM, NC 27713
(919) 248-0850
(919) 248-0935

Taxonomy

Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
00992
NC

Other

Enumeration date
09/12/2012
Last updated
05/27/2014
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