Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Customized Equipment |
332BC3200X | 87 | All Other Suppliers | |
Athletic Trainer |
2255A2300X | |||
Pedorthist |
224L00000X | |||
Prosthetic/Orthotic Supplier |
335E00000X | 51 | Medical Supply Company with Orthotist |
| NPI Number | 1639650054 |
| LBN Legal business name | PINNACLE ORTHOTICS, LLC |
| Authorized official | JARRED GIBSON - (OWNER) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 08/23/2018 |
| Last updated | 11/07/2019 - About 7 years ago |
| Identifiers | n/a |
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