Healthcare Provider Details

I. General information

NPI: 1417142001
Provider Name (Legal Business Name): ARISE ORTHOTICS & PROSTHETICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8338 HIGHWAY 65 NE STE E
SPRING LAKE PARK MN
55432-1365
US

IV. Provider business mailing address

8338 HIGHWAY 65 NE STE E
SPRING LAKE PARK MN
55432-1365
US

V. Phone/Fax

Practice location:
  • Phone: 763-755-9500
  • Fax: 763-755-9510
Mailing address:
  • Phone: 763-755-9500
  • Fax: 763-755-9510

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
Identifier376627000
Identifier TypeMEDICAID
Identifier StateMN
Identifier Issuer

VIII. Authorized Official

Name: THERESE KUFFEL
Title or Position: VICE PRESIDENT
Credential:
Phone: 763-755-9500