Organization
EXPRESS ORTHOTICS & PROSTHETICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHANE EVANS WAKEFIELD CPO/LPO (OWNER)
(813) 605-4610
Entity
Organization
Contact information
Practice address
3603 W FLORA ST, TAMPA, FL 33614-4025
(813) 605-4610
(813) 605-4612
Mailing address
3603 W FLORA ST, TAMPA, FL 33614-4025
(813) 605-4610
(813) 605-4612
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
POR249
FL
Other
Enumeration date
01/28/2015
Last updated
07/27/2015
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