Healthcare Provider Details

I. General information

NPI: 1558545418
Provider Name (Legal Business Name): DYNAMIC PROSTHETIC & ORTHOTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 WESTSIDE DR NW SUITE 306
CLEVELAND TN
37312-3699
US

IV. Provider business mailing address

2700 WESTSIDE DR NW SUITE 306
CLEVELAND TN
37312-3699
US

V. Phone/Fax

Practice location:
  • Phone: 423-478-5093
  • Fax: 423-622-2400
Mailing address:
  • Phone: 423-478-5093
  • Fax: 423-622-2400

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: MR. AMY ROOKS SMITH
Title or Position: MANAGER
Credential:
Phone: 423-622-2000