Healthcare Provider Details

I. General information

NPI: 1588062764
Provider Name (Legal Business Name): PROSTHETIC & ORTHOTIC GROUP PEDIATRIC SPECIALISTS - COLORADO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2014
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13123 E 16TH AVE MAIL BOX B060
AURORA CO
80045-7106
US

IV. Provider business mailing address

37 SHUMAN AVE
STOUGHTON MA
02072-3734
US

V. Phone/Fax

Practice location:
  • Phone: 303-400-8866
  • Fax: 970-416-9359
Mailing address:
  • Phone: 508-638-1172
  • Fax: 508-588-7944

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: THOMAS H MORRISSEY
Title or Position: GENERAL MANAGER
Credential:
Phone: 508-588-6060