Healthcare Provider Details

I. General information

NPI: 1750656039
Provider Name (Legal Business Name): SOUND LIMBS ORTHOTICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 MALLETT DR SUITE 102
FREEPORT ME
04032-1312
US

IV. Provider business mailing address

39 S LISBON RD
LEWISTON ME
04240-1404
US

V. Phone/Fax

Practice location:
  • Phone: 207-865-6060
  • Fax: 207-865-6061
Mailing address:
  • Phone: 207-784-4345
  • Fax: 207-783-9496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier126940000
Identifier TypeMEDICAID
Identifier StateME
Identifier Issuer

VIII. Authorized Official

Name: MRS. ELIZABETH A.M. PARK
Title or Position: CO-OWNER
Credential:
Phone: 207-784-4345