Healthcare Provider Details

I. General information

NPI: 1760225148
Provider Name (Legal Business Name): ORTHOTIC PROSTHETIC SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 BELLE CHASSE HWY STE C
GRETNA LA
70056-7156
US

IV. Provider business mailing address

7754 FLORIDA BLVD
BATON ROUGE LA
70806-4706
US

V. Phone/Fax

Practice location:
  • Phone: 504-269-3915
  • Fax: 504-324-0820
Mailing address:
  • Phone: 225-316-5444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DANDRE SHONDALE MOSTELLA
Title or Position: OWNER
Credential:
Phone: 225-316-5444