Healthcare Provider Details

I. General information

NPI: 1093195745
Provider Name (Legal Business Name): RIVERVIEW ORTHOTICS PROSTHETICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 02/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 ATRIUM CT SUITE B
SELINSGROVE PA
17870-9019
US

IV. Provider business mailing address

2 ATRIUM CT SUITE B
SELINSGROVE PA
17870-9019
US

V. Phone/Fax

Practice location:
  • Phone: 570-743-1414
  • Fax: 570-743-5215
Mailing address:
  • Phone: 570-743-1414
  • Fax: 570-743-5215

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: GRACE ANGELINE
Title or Position: REG COMPLIANCE SPECIALIST III
Credential:
Phone: 714-961-2102