Organization
VICTORY ORTHOTICS & PROSTHETICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRAD GARDNER CPO (COO)
(615) 864-8790
Entity
Organization
Contact information
Practice address
9051 EXECUTIVE PARK DR STE 100, KNOXVILLE, TN 37923-4651
(865) 249-8852
(865) 249-8674
Mailing address
102 WOODMONT BLVD STE 120, NASHVILLE, TN 37205-5249
(615) 864-8790
(615) 454-5352
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
205596
TN
Other
Enumeration date
11/21/2016
Last updated
08/13/2020
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