Healthcare Provider Details

I. General information

NPI: 1689706053
Provider Name (Legal Business Name): ORTHOPRO OF TWIN FALLS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1437 PARKVIEW DR STE 200
TWIN FALLS ID
83301-4167
US

IV. Provider business mailing address

1437 PARKVIEW DR STE 200
TWIN FALLS ID
83301-4167
US

V. Phone/Fax

Practice location:
  • Phone: 208-733-0505
  • Fax: 208-735-2117
Mailing address:
  • Phone: 208-733-0505
  • Fax: 208-735-2117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL SCOTT JOHNSON
Title or Position: OWNER/CPO
Credential:
Phone: 208-733-0505