Healthcare Provider Details

I. General information

NPI: 1447729553
Provider Name (Legal Business Name): REFORM PROSTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 KEYSTONE DR STE F
MAUMEE OH
43537-8796
US

IV. Provider business mailing address

3652 DEER CREEK DR
MAUMEE OH
43537-7902
US

V. Phone/Fax

Practice location:
  • Phone: 419-322-2303
  • Fax:
Mailing address:
  • Phone: 865-297-6600
  • Fax:

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: ZACHARY WEBER
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 865-297-6600