Healthcare Provider Details

I. General information

NPI: 1205878535
Provider Name (Legal Business Name): PROSTHETIC INNOVATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 12/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 INDUSTRIAL HWY
EDDYSTONE PA
19022-1522
US

IV. Provider business mailing address

1400 INDUSTRIAL HWY
EDDYSTONE PA
19022-1522
US

V. Phone/Fax

Practice location:
  • Phone: 610-447-8777
  • Fax: 610-447-0932
Mailing address:
  • Phone: 610-447-8777
  • Fax: 610-447-0932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number6000006880
License Number StatePA

VIII. Authorized Official

Name: TIMOTHY RAYER
Title or Position: PARTNER
Credential: CP
Phone: 610-447-8777