Provider Demographics
NPI:1528243177
Name:BOSTON BRACE INTERNATIONAL INC.
Entity type:Organization
Organization Name:BOSTON BRACE INTERNATIONAL INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANANGER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:MORRISSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-588-6060
Mailing Address - Street 1:37 SHUMAN AVE
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3734
Mailing Address - Country:US
Mailing Address - Phone:508-638-1172
Mailing Address - Fax:
Practice Address - Street 1:6555 NOVA DR
Practice Address - Street 2:SUITE 306
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33317-7404
Practice Address - Country:US
Practice Address - Phone:954-424-1168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025484300Medicaid
FL025484300Medicaid