MEDICARE: DFW ORTHOTICS AND PROSTHETICS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1295222180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DFW ORTHOTICS AND PROSTHETICS, LLC

Provider Business Mailing Address
First Line	:	1721 W PLANO PKWY STE 212
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75075-8600
Country	:	US
Telephone Number	:	214-325-7639
Fax Number	:

Provider Business Practice Location Address
First Line	:	1721 W PLANO PKWY STE 212
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75075-8600
Country	:	US
Telephone Number	:	214-325-7639
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRACTITIONER
Name	:	PHUOC NGUYEN
Credential	:	LPO, CPO
Telephone Number	:	214-325-7639

Provider Enumeration Date	:	04/17/2018
Last Update Date	:	04/17/2018

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