Organization
M & M REHAB INC
Active
Other names
MID-FLORIDA PROSTHETICS & ORTHOTICS
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VICTOR BUSTAMANTE LPO (OWNER)
(352) 331-3399
Entity
Organization
Contact information
Practice address
6608 NW 9TH BLVD, GAINESVILLE, FL 32605-4207
(352) 331-3399
(352) 331-9927
Mailing address
6608 NW 9TH BLVD, GAINESVILLE, FL 32605-4207
(352) 331-3399
(352) 331-9927
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
ORT 62
FL
335E00000X
Prosthetic/Orthotic Supplier
Primary
POR 89
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021922300
—
FL
Enumeration date
06/01/2005
Last updated
08/07/2020
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