Healthcare Provider Details

I. General information

NPI: 1548284029
Provider Name (Legal Business Name): PERROTTA PROSTHETICS AND ORTHOTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 DOWD AVE
CANTON CT
06019-2401
US

IV. Provider business mailing address

141 DOWD AVE
CANTON CT
06019-2401
US

V. Phone/Fax

Practice location:
  • Phone: 860-693-6932
  • Fax: 860-693-6820
Mailing address:
  • Phone: 860-693-6932
  • Fax: 860-693-6820

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: LOUIS M PERROTTA
Title or Position: MANAGER/MEMBER
Credential: CPO
Phone: 860-693-6932