Organization
PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES - SOUTHEAST, LLC
Active
Parent organization
PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES - SOUTHEAST, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES - SOUTHEAST, LLC
Authorized official
MS. JOANNE KANAS (EXECUTIVE DIRECTOR O&P)
(813) 975-7139
Entity
Organization
Contact information
Practice address
15511 N FLORIDA AVE STE 102, TAMPA, FL 33613-1263
(813) 975-7139
(813) 631-7160
Mailing address
PO BOX 947109, ATLANTA, GA 30394-7109
(813) 367-2876
(813) 518-7659
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
4184
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004604300
—
FL
Enumeration date
10/20/2011
Last updated
09/25/2025
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