Healthcare Provider Details

I. General information

NPI: 1073082392
Provider Name (Legal Business Name): PRECISION ORTHOTICS & PROSTHETICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7350 W CHEYENNE AVE STE 110
LAS VEGAS NV
89129-7407
US

IV. Provider business mailing address

526 S TONOPAH DR STE 120
LAS VEGAS NV
89106-4044
US

V. Phone/Fax

Practice location:
  • Phone: 702-243-7671
  • Fax: 702-259-7671
Mailing address:
  • Phone: 702-243-7671
  • Fax: 702-259-7671

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: AARON KRATOHVIL
Title or Position: VP OF FINANCE, CONTROLLER
Credential:
Phone: 615-550-8760