Healthcare Provider Details

I. General information

NPI: 1669472692
Provider Name (Legal Business Name): LAWALL PROSTHETICS ORTHOTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1822 AUGUSTINE CUT OFF
WILMINGTON DE
19803-4405
US

IV. Provider business mailing address

3000 CABOT BLVD W
LANGHORNE PA
19047-1800
US

V. Phone/Fax

Practice location:
  • Phone: 302-735-4630
  • Fax: 302-427-3682
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 Number2003107597
License Number StateDE

VIII. Authorized Official

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