MEDICARE: PROSTHETIX SHOP 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	304	OH

General Provider Information

NPI Number	:	1932446812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSTHETIX SHOP LLC

Provider Business Mailing Address
First Line	:	431 OHIO PIKE
Second Line	:	SUITE 124 SOUTH
City	:	CINCINNATI
State	:	OH
Zip	:	45255-3375
Country	:	US
Telephone Number	:	513-843-5126
Fax Number	:	513-843-5164

Provider Business Practice Location Address
First Line	:	431 OHIO PIKE
Second Line	:	SUITE 124 SOUTH
City	:	CINCINNATI
State	:	OH
Zip	:	45255-3375
Country	:	US
Telephone Number	:	513-843-5126
Fax Number	:	513-843-5164

Authorized Official
Title or Position	:	OWNER
Name	:	AARON MOLES
Credential	:	LP
Telephone Number	:	513-843-5126

Provider Enumeration Date	:	01/11/2013
Last Update Date	:	03/29/2022

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Directions to “PROSTHETIX SHOP LLC ” Practice Location

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