Organization
PSL ORTHOTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LILIYA HERETSUN-ROUSSONICOLOS (OWNER)
(772) 207-6266
Entity
Organization
Contact information
Practice address
679 SW WHITMORE DR STE 2, PORT ST LUCIE, FL 34984-3567
(772) 249-0141
(772) 249-0445
Mailing address
679 SW WHITMORE DR STE 2, PORT ST LUCIE, FL 34984-3567
(772) 207-6266
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
11/30/2020
Last updated
12/04/2020
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