Individual
TRACEY LEA LIPUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4647 CLYDE MORRIS BLVD UNIT 501, PORT ORANGE, FL 32129-3001
(386) 293-1016
Mailing address
4647 CLYDE MORRIS BLVD UNIT 501, PORT ORANGE, FL 32129-3001
(386) 293-1016
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
11/06/2025
Last updated
11/06/2025
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