Provider Demographics
NPI:1174526396
Name:SONLIFE PROSTHETICS & ORTHOTICS, INC.
Entity type:Organization
Organization Name:SONLIFE PROSTHETICS & ORTHOTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:GORIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPO
Authorized Official - Phone:352-596-2257
Mailing Address - Street 1:6111 DELTONA BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-1011
Mailing Address - Country:US
Mailing Address - Phone:352-596-2257
Mailing Address - Fax:352-596-0180
Practice Address - Street 1:6111 DELTONA BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-1011
Practice Address - Country:US
Practice Address - Phone:352-596-2257
Practice Address - Fax:352-596-0180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR 16335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL027898000Medicaid
FL0445550001Medicare NSC