Healthcare Provider Details

I. General information

NPI: 1417562695
Provider Name (Legal Business Name): ARIZONA ORTHOTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8618 N 35TH AVE STE 1A
PHOENIX AZ
85051-3800
US

IV. Provider business mailing address

7521 S OLYMPIA AVE # 1041
TULSA OK
74132-1855
US

V. Phone/Fax

Practice location:
  • Phone: 918-830-1090
  • Fax:
Mailing address:
  • Phone: 918-830-1090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER PARKS
Title or Position: MANAGING MEMBER
Credential: AUTH. OFFICIAL
Phone: 918-830-1090