Healthcare Provider Details

I. General information

NPI: 1629043047
Provider Name (Legal Business Name): PRECISION ORTHOTICS & PROSTHETICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8915 S PECOS RD SUITE 18A
HENDERSON NV
89074-7149
US

IV. Provider business mailing address

102 WOODMONT BLVD STE 120
NASHVILLE TN
37205-5249
US

V. Phone/Fax

Practice location:
  • Phone: 702-243-7671
  • Fax: 702-259-7671
Mailing address:
  • Phone: 615-864-8790
  • Fax: 615-454-5352

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: BRADFORD GARDNER
Title or Position: COO
Credential:
Phone: 615-864-8783