Healthcare Provider Details

I. General information

NPI: 1972417657
Provider Name (Legal Business Name): EXTREME PROSTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

922 TRIPLETT ST STE 5
OWENSBORO KY
42303-3118
US

IV. Provider business mailing address

922 TRIPLETT ST STE 5
OWENSBORO KY
42303-3118
US

V. Phone/Fax

Practice location:
  • Phone: 270-713-8868
  • Fax: 270-889-5014
Mailing address:
  • Phone: 270-713-8868
  • Fax: 270-889-5014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. WILLIAM EARL BRAY JR.
Title or Position: OWNER/MANAGER
Credential: CPO
Phone: 270-713-8868