Organization
GULF COAST ORTHOTICS & PROSTHETICS CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LILLIANE M RODERIQUES (OWNER)
(941) 408-6246
Entity
Organization
Contact information
Practice address
21300 GERTRUDE AVE, PORT CHARLOTTE, FL 33952-5002
(941) 408-6246
(941) 249-8956
Mailing address
21300 GERTRUDE AVE, PORT CHARLOTTE, FL 33952-5002
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
POR181
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0324051 00
—
FL
Enumeration date
02/04/2014
Last updated
03/21/2014
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