Healthcare Provider Details

I. General information

NPI: 1891751723
Provider Name (Legal Business Name): DENHAM ORTHOTICS AND FITNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 01/03/2021
Certification Date: 01/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 WHITNEY RANCH DR #C-17
HENDERSON NV
89014-2642
US

IV. Provider business mailing address

601 WHITNEY RANCH DR #C-17
HENDERSON NV
89014-2642
US

V. Phone/Fax

Practice location:
  • Phone: 702-898-6000
  • Fax: 702-898-6080
Mailing address:
  • Phone: 702-898-6000
  • Fax: 702-898-6080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCO003963
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCP003298
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberC15202
License Number StateNV

VIII. Authorized Official

Name: DAVID KOVACH
Title or Position: PRESIDENT
Credential: CP,BOCO
Phone: 702-898-6000