Healthcare Provider Details

I. General information

NPI: 1578403101
Provider Name (Legal Business Name): SRT PROSTHETICS & ORTHOTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 AMELIA AVE STE B
LAFAYETTE IN
47905-5772
US

IV. Provider business mailing address

102 WOODMONT BLVD STE 400
NASHVILLE TN
37205-5217
US

V. Phone/Fax

Practice location:
  • Phone: 317-296-7330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: BRADFORD GARDNER
Title or Position: DIR OF FINANCE
Credential:
Phone: 615-864-8783