Healthcare Provider Details

I. General information

NPI: 1629306352
Provider Name (Legal Business Name): PRECISION ORTHOTIC & PROSTHETIC TECHNOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2009
Last Update Date: 11/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HANOVER ST SUITE 1G
FALL RIVER MA
02720-5444
US

IV. Provider business mailing address

300 HANOVER ST SUITE 1G
FALL RIVER MA
02720-5444
US

V. Phone/Fax

Practice location:
  • Phone: 508-991-5577
  • Fax: 508-991-5505
Mailing address:
  • Phone: 508-991-5577
  • Fax: 508-991-5505

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: MR. MATTHEW E HEBERT
Title or Position: PRESIDENT
Credential: CPO CFO
Phone: 508-991-5577