Organization
CUSTOM ORTHOTICS & PROSTHETICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JASON D. JOYCE (PRESIDENT)
(423) 247-0032
Entity
Organization
Contact information
Practice address
1567 NORTH EASTMAN RD, STE 4, KINGSPORT, TN 37664-2680
(423) 247-0032
(423) 247-0038
Mailing address
1567 NORTH EASTMAN RD, STE 4, KINGSPORT, TN 37664-2680
(423) 247-0032
(423) 247-0038
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
BOCO 15072
TN
Other
Enumeration date
09/22/2006
Last updated
10/05/2011
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