Organization
VICTORY ORTHOTICS & PROSTHETICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRAD GARDNER (COO)
(615) 864-8790
Entity
Organization
Contact information
Practice address
2333 KNOB CREEK RD STE 14, JOHNSON CITY, TN 37604
(423) 461-3320
Mailing address
102 WOODMONT BLVD STE 120, NASHVILLE, TN 37205-5249
(615) 550-8774
(156) 454-5352
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1454184
—
TN
01
—
4017529
BCBSTN
TN
05
—
9190601
—
VA
Enumeration date
09/28/2006
Last updated
10/03/2018
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