Organization
COLLINS ORTHOPEDIC LAB INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DALE HOWARD COLLINS LPO (CEO)
(407) 388-0141
Entity
Organization
Contact information
Practice address
320 PINEY RIDGE RD, CASSELBERRY, FL 32707-3806
(407) 388-0141
(407) 388-1121
Mailing address
320 PINEY RIDGE RD, CASSELBERRY, FL 32707-3806
(407) 388-0141
(407) 388-1121
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
POR 120
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
POR 120
LICENSE P & O
FL
Enumeration date
09/17/2006
Last updated
04/03/2013
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