Healthcare Provider Details

I. General information

NPI: 1376549568
Provider Name (Legal Business Name): ACHILLES PROSTHETICS AND ORTHOTICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 09/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 E MAIN ST
SANTA MARIA CA
93454-4506
US

IV. Provider business mailing address

622 E MAIN ST
SANTA MARIA CA
93454-4506
US

V. Phone/Fax

Practice location:
  • Phone: 805-925-6144
  • Fax: 805-925-2746
Mailing address:
  • Phone: 805-925-6144
  • Fax: 805-925-2746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DANIEL J NEWTON
Title or Position: PRESIDENT
Credential: B.S,, F.A.C., C.P.
Phone: 661-323-5944