Healthcare Provider Details

I. General information

NPI: 1013173848
Provider Name (Legal Business Name): SPECTRUM PROSTHETICS & ORTHOTICS OF REDDING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1399 MONTGOMERY RD
RED BLUFF CA
96080-4604
US

IV. Provider business mailing address

1844 SOUTH ST
REDDING CA
96001-1809
US

V. Phone/Fax

Practice location:
  • Phone: 530-528-2200
  • Fax: 530-528-2290
Mailing address:
  • Phone: 530-243-4500
  • Fax: 530-243-4554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: TINA ZELLER
Title or Position: OFFICE MANAGER
Credential:
Phone: 530-243-4500