Healthcare Provider Details

I. General information

NPI: 1013536622
Provider Name (Legal Business Name): ANIMATE PEDORTHICS ORTHOTICS & PROSTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 04/16/2020
Certification Date: 04/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 W SAINT PAUL ST
SPRING VALLEY IL
61362-1860
US

IV. Provider business mailing address

5512 S WASHINGTON ST
HINSDALE IL
60521-4914
US

V. Phone/Fax

Practice location:
  • Phone: 312-315-6584
  • Fax:
Mailing address:
  • Phone: 312-315-6584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224L00000X
TaxonomyPedorthist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: EDGAR ALEXANDER BARRIOS
Title or Position: OWNER/CEO
Credential: PEDORTHIST
Phone: 312-315-6584