Healthcare Provider Details

I. General information

NPI: 1073508412
Provider Name (Legal Business Name): SOUND LIMBS ORTHOTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 S LISBON RD
LEWISTON ME
04240-1404
US

IV. Provider business mailing address

39 S LISBON RD
LEWISTON ME
04240-1404
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name: MR. ROGER D PARK JR.
Title or Position: PRESIDENT
Credential: C.O.
Phone: 207-784-4345