Healthcare Provider Details

I. General information

NPI: 1972571438
Provider Name (Legal Business Name): LAWALL PROSTHETICS ORTHOTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 N DUPONT HWY
DOVER DE
19901-3961
US

IV. Provider business mailing address

3000 CABOT BLVD W
LANGHORNE PA
19047-1800
US

V. Phone/Fax

Practice location:
  • Phone: 302-677-0693
  • Fax: 302-677-0930
Mailing address:
  • Phone: 215-338-6611
  • Fax: 215-338-9579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number2003106529
License Number StateDE

VIII. Authorized Official

Name: MR. WAYNE T LAWALL
Title or Position: PRESIDENT
Credential: CPO
Phone: 215-338-6611