John C Fredrick, LPO
Individual provider Active NPI Prosthetic/Orthotic Supplier · Gotha, FL
NPI 1922600345 · NPPES record last updated Nov 10, 2020
Key facts
- NPI
- 1922600345
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Prosthetic/Orthotic Supplier 335E00000X
- License
- POR13 (FL)
- Practice address
- 9259 Lake Fischer Blvd
Gotha, FL 34734-5204 - Phone
- (850) 247-8975
- NPI assigned
- Nov 10, 2020
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| POR13 | FL | MD | Prosthetic/Orthotic Supplier |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Institute for Prosthetic Advancement | Prosthetic/Orthotic Supplier | Current | Accepting new patients |
| Power Prosthetic Solutions LLC | Prosthetic/Orthotic Supplier | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthetic/Orthotic Supplier | 335E00000X | POR13 | FL | Yes |
Addresses
Primary practice location
9259 Lake Fischer Blvd
Gotha, FL 34734-5204
Mailing address
9259 Lake Fischer Blvd
Gotha, FL 34734-5204
Phone (850) 247-8975
Other providers in Gotha, FL
- Renee Castile
- Carla C Chen
- Ebency Chevelon
- Raquel Cobbs
- Purvi Desai
- Michelle Fredrick
- Gencare Therapy Inc.
- Home Therapy Partners, LLC
- Insyte Biomed LLC
- Mark G Brooks M D P a
All providers in Gotha, FL · Prosthetic/Orthotic Supplier in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 10, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.