Healthcare Provider Details

I. General information

NPI: 1639173537
Provider Name (Legal Business Name): SPECTRUM PROSTHETICS & ORTHOTICS OF REDDING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1844 SOUTH ST
REDDING CA
96001-1809
US

IV. Provider business mailing address

1844 SOUTH ST
REDDING CA
96001-1809
US

V. Phone/Fax

Practice location:
  • Phone: 530-243-4500
  • Fax: 530-243-4554
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: MR. JEFF A ZELLER
Title or Position: OWNER
Credential: C.P.
Phone: 530-243-4500