Healthcare Provider Details

I. General information

NPI: 1407855760
Provider Name (Legal Business Name): THE ORTHOPEDIC STORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8311 BURNET RD
AUSTIN TX
78757-7714
US

IV. Provider business mailing address

PO BOX 792590
SAN ANTONIO TX
78279-2590
US

V. Phone/Fax

Practice location:
  • Phone: 512-302-9370
  • Fax: 512-302-9374
Mailing address:
  • Phone: 512-302-9370
  • Fax: 512-302-9370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0046447
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number101021
License Number StateTX

VIII. Authorized Official

Name: JOHN RANDOLPH HARIG
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 210-366-2990