Organization
COUNTRY COBBLER, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MONTY K. MANTEY (PRESIDENT/OWNER)
(910) 772-9994
Entity
Organization
Contact information
Practice address
255 N EQUITY DR STE A, SMITHFIELD, NC 27577-6054
(919) 989-6190
(919) 989-6127
Mailing address
255 N EQUITY DR STE A, SMITHFIELD, NC 27577-6054
(919) 989-6190
(919) 989-6127
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
00992
NC
Other
Enumeration date
07/30/2012
Last updated
05/27/2014
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