Country Cobbler, LTD.

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

00992 Issued in NC

Legal business name

COUNTRY COBBLER, LTD.

Practice address

6815 Fayetteville Road
#102
Durham, NC 27713-7081

Phone

(919) 248-0850

Fax

(919) 248-0935

NPI assigned

Sep 12, 2012

Last updated

May 27, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Monty K. Mantey

Title

President/Ownder

Phone

(910) 772-9994

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1347408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401148800000",
    "number": "1255681797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6815 FAYETTEVILLE ROAD",
            "address_2": "#102",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "27713",
            "telephone_number": "919-248-0850",
            "fax_number": "919-248-0935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6815 FAYETTEVILLE ROAD",
            "address_2": "#102",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277137081",
            "telephone_number": "919-248-0850",
            "fax_number": "919-248-0935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY COBBLER, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-12",
        "last_updated": "2014-05-27",
        "status": "A",
        "authorized_official_last_name": "MANTEY",
        "authorized_official_first_name": "MONTY",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "PRESIDENT/OWNDER",
        "authorized_official_telephone_number": "910-772-9994",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NC",
            "license": "00992",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Prosthetic/Orthotic Supplier in Durham, NC
• Providers in Durham, NC by specialty
• Prosthetic/Orthotic Supplier in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.