OrganizationActive
Intercoastal Orthotics & Prosthetics, LLC
NPI 1083839062 · Prosthetic/Orthotic Supplier · Edgewater, FL
Provider details
- NPI number
- 1083839062
- Entity type
- Organization
- Primary specialty
- Prosthetic/Orthotic SupplierSuppliers
- Organization subpart
- No
- Authorized official
- Tom Mowery, Prosthetist, Orthotist(386) 409-9432
- License
- POR 162 (FL)
Specialties & taxonomies
Suppliers
Practice location
1 Pelican Dr Ste a
Edgewater, FL 32141-4254
Phone: (386) 409-9432
Fax: (386) 409-9433
Approximate (ZIP-level) locationGet directions
Mailing address
1 Pelican Dr Ste a
Edgewater, FL 32141-4254
Registry dates
- Enumerated
- 2007-04-16
- Last updated
- 2009-08-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.