Organization
GULF COAST ORTHOTICS & PROSTHETICS CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH RODERIQUES CPO (OWNER)
(941) 497-3800
Entity
Organization
Contact information
Practice address
4120 WOODMERE PARK BLVD, SUITE 7, VENICE, FL 34293-5373
(941) 497-3800
(941) 497-7775
Mailing address
4120 WOODMERE PARK BLVD, SUITE 7, VENICE, FL 34293-5373
(941) 497-3800
(941) 497-7775
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
POR 181
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
749649
—
FL
Enumeration date
09/16/2007
Last updated
06/20/2019
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