PSL Orthotics, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

PSL ORTHOTICS, LLC

Practice address

679 SW Whitmore Dr Ste 2
Port St Lucie, FL 34984-3567

Phone

(772) 249-0141

Fax

(772) 249-0445

NPI assigned

Nov 30, 2020

Last updated

Dec 4, 2020By 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

Liliya Heretsun-RoussonicolosNPI 1407464506

Title

Owner

Phone

(772) 207-6266

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Liliya Heretsun-Roussonicolos

  • Durable Medical Equipment & Medical Supplies
  • Port St Lucie, FL
  • NPI 1407464506
  NPD Authorized official

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

{
    "created_epoch": "1606694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607040000000",
    "number": "1396349312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "679 SW WHITMORE DR STE 2",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349843567",
            "telephone_number": "772-207-6266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "679 SW WHITMORE DR STE 2",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349843567",
            "telephone_number": "772-249-0141",
            "fax_number": "772-249-0445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSL ORTHOTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-30",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-04",
        "status": "A",
        "authorized_official_last_name": "HERETSUN-ROUSSONICOLOS",
        "authorized_official_first_name": "LILIYA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "772-207-6266"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• Durable Medical Equipment & Medical Supplies in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2020; 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.