OrganizationActive
Vital Prosthetics, Inc.
NPI 1114189669 · Prosthetic/Orthotic Supplier · Marianna, FL
Provider details
- NPI number
- 1114189669
- Entity type
- Organization
- Primary specialty
- Prosthetic/Orthotic SupplierSuppliers
- Organization subpart
- No
- Authorized official
- Dale Petersen, Pres/Owner(850) 526-0063
- License
- PRO 66 (FL)
Specialties & taxonomies
Suppliers
Profile Score
Detailed profile(87/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
17 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
4299 3rd Ave
Marianna, FL 32446-2136
Phone: (850) 526-0063
Fax: (850) 526-1317
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 430
Marianna, FL 32447-0430
Registry dates
- Enumerated
- 2008-06-26
- Last updated
- 2008-09-18
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.