Healthcare Provider Details

I. General information

NPI: 1629130182
Provider Name (Legal Business Name): PRESCOTT LIMB & BRACES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 N LLANO ST
FREDERICKSBURG TX
78624-3922
US

IV. Provider business mailing address

6715 SAN PEDRO AVE
SAN ANTONIO TX
78216-7218
US

V. Phone/Fax

Practice location:
  • Phone: 830-990-8925
  • Fax: 830-606-3829
Mailing address:
  • Phone: 210-224-0726
  • Fax: 210-341-3164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number101009
License Number StateTX

VIII. Authorized Official

Name: MR. GARY WAYNE PRESCOTT
Title or Position: OWNER
Credential: C.O.
Phone: 830-990-8925