Healthcare Provider Details

I. General information

NPI: 1003058595
Provider Name (Legal Business Name): PROSTHETIC CONSULTING TECHNOLOGIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 12/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 US HIGHWAY 395 N SUITE 303
CARSON CITY NV
89704-9582
US

IV. Provider business mailing address

220 US HIGHWAY 395 N SUITE 303
CARSON CITY NV
89704-9582
US

V. Phone/Fax

Practice location:
  • Phone: 775-849-0958
  • Fax: 775-849-2566
Mailing address:
  • Phone: 775-849-0958
  • Fax: 775-849-2566

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. RICHARD L RILEY
Title or Position: OWNER/OPERATOR
Credential: CP
Phone: 775-830-1783