Healthcare Provider Details

I. General information

NPI: 1497026074
Provider Name (Legal Business Name): CAPITAL ORTHOTICS & PROSTHETICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 01/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 NELSON ST 1ST FLOOR
MANCHESTER NH
03103
US

IV. Provider business mailing address

246 PLEASANT ST SUITE 200
CONCORD NH
03301-2548
US

V. Phone/Fax

Practice location:
  • Phone: 603-425-0106
  • Fax: 603-425-0108
Mailing address:
  • Phone: 603-226-0106
  • Fax: 603-226-0845

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. GEORGE T ROGERS
Title or Position: OWNER
Credential: C.O.
Phone: 603-226-0106