Provider Demographics
NPI:1538823703
Name:ROCKET ORTHOTICS & SUPPLY CORP
Entity type:Organization
Organization Name:ROCKET ORTHOTICS & SUPPLY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:REZILTA
Authorized Official - Middle Name:
Authorized Official - Last Name:REHABILITATION SERVICES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-233-9283
Mailing Address - Street 1:1926 HOLLYWOOD BLVD # 304-128
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-4532
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1926 HOLLYWOOD BLVD # 304-128
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4532
Practice Address - Country:US
Practice Address - Phone:561-247-5577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthistGroup - Multi-Specialty
No335E00000XSuppliersProsthetic/Orthotic Supplier