Healthcare Provider Details

I. General information

NPI: 1265488811
Provider Name (Legal Business Name): MUILENBURG PROSTHETICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 01/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 LA BRANCH ST
HOUSTON TX
77004
US

IV. Provider business mailing address

PO BOX 8313
HOUSTON TX
77288-8313
US

V. Phone/Fax

Practice location:
  • Phone: 713-524-3949
  • Fax: 713-524-3915
Mailing address:
  • Phone: 713-524-3949
  • Fax: 713-524-3915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number407
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateTX

VIII. Authorized Official

Name: MR. TED BRUCE MUILENBURG
Title or Position: PRESIDENT
Credential: CP
Phone: 713-524-3949