Healthcare Provider Details

I. General information

NPI: 1659483725
Provider Name (Legal Business Name): CENTRAL TEXAS ORTHOTICS & PROSTHETICS, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 E VILLA MARIA RD
BRYAN TX
77802-2542
US

IV. Provider business mailing address

PO BOX 650846
DALLAS TX
75265-0846
US

V. Phone/Fax

Practice location:
  • Phone: 979-731-1985
  • Fax: 979-776-8447
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: HEATHER PETERS
Title or Position: REGULATORY COMPLIANCE ANALYST II
Credential:
Phone: 859-594-2713