Healthcare Provider Details

I. General information

NPI: 1245233642
Provider Name (Legal Business Name): WILLIAMSPORT ORTHOPEDIC & PROSTHETIC COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 PENN ST STE 1
WILLIAMSPORT PA
17701-5310
US

IV. Provider business mailing address

251 PENN ST STE 1
WILLIAMSPORT PA
17701-5310
US

V. Phone/Fax

Practice location:
  • Phone: 570-322-5277
  • Fax: 570-322-1289
Mailing address:
  • Phone: 570-322-5277
  • Fax: 570-322-1289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KATHLEEN BORGESS
Title or Position: PRESIDENT
Credential: BOC-O
Phone: 570-322-5277