Victory Orthotics & Prosthetics LLC
Prosthetic/Orthotic Supplier in Bristol, TN. Organization (NPI-2).
NPI number1861664047
StatusActive
Last updated in NPPESOct 3, 2018
Details
- NPI
- 1861664047
- Entity type
- Organization (NPI-2)
- Legal business name
- Victory Orthotics & Prosthetics LLC
- Organization subpart
- No
- Enumeration date
- Mar 28, 2008
- Last updated
- Oct 3, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 335E00000X | Prosthetic/Orthotic Supplier | – | TN | Yes |
Practice location
324 Steeles RdBristol, TN 37620
Phone 423-323-1927
Mailing address
102 Woodmont Blvd Ste 120Nashville, TN 37205-5249
Phone 615-550-8774 · Fax 615-550-8774
Authorized official
Brad Gardner
Coo
6158648790
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