Healthcare Provider Details

I. General information

NPI: 1609170737
Provider Name (Legal Business Name): PRECISION ORTHOTICS & PROSTHETICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2011
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 S TONOPAH DR SUITE 120
LAS VEGAS NV
89106-4043
US

IV. Provider business mailing address

526 S TONOPAH DR SUITE 120
LAS VEGAS NV
89106-4043
US

V. Phone/Fax

Practice location:
  • Phone: 702-243-7671
  • Fax: 702-259-7671
Mailing address:
  • Phone: 702-293-5502
  • 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: BRADFORD GARDNER
Title or Position: COO
Credential:
Phone: 615-864-8783