Organization
SPACE COAST PROSTHETICS AND ORTHOTICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL PONO MCDOWELL CPO (VICE PRESIDENT/CO-OWNER)
(321) 877-4732
Entity
Organization
Contact information
Practice address
590 SOLUTIONS WAY STE 100, ROCKLEDGE, FL 32955-3623
(321) 877-4732
(321) 877-4735
Mailing address
590 SOLUTIONS WAY STE 100, ROCKLEDGE, FL 32955-3623
(321) 877-4732
(321) 877-4735
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
POR 134
FL
224P00000X
Prosthetist
Primary
POR 134
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
15382200
—
FL
Enumeration date
03/20/2015
Last updated
09/17/2021
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