Organization
COUNTRY COBBLER, LTD.
Active
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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