Healthcare Provider Details

I. General information

NPI: 1003736620
Provider Name (Legal Business Name): CATALYST ORTHOTIC AND PROSTHETIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 CONNECTICUT AVE
JOPLIN MO
64804-3022
US

IV. Provider business mailing address

2312 CONNECTICUT AVE
JOPLIN MO
64804-3022
US

V. Phone/Fax

Practice location:
  • Phone: 417-659-8488
  • Fax:
Mailing address:
  • Phone: 417-659-8488
  • Fax:

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: SANJAY GUPTA
Title or Position: OWNER
Credential:
Phone: 417-659-8488