Healthcare Provider Details

I. General information

NPI: 1700972361
Provider Name (Legal Business Name): BIO PROSTHETIC-ORTHOTIC LAB, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21785 FILIGREE COURT SUITE 210
ASHBURN VA
20147
US

IV. Provider business mailing address

21785 FILIGREE COURT SUITE 210
ASHBURN VA
20147
US

V. Phone/Fax

Practice location:
  • Phone: 703-726-4092
  • Fax: 703-726-4095
Mailing address:
  • Phone: 703-726-4092
  • Fax: 703-726-4095

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 TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIC SHAWN FORD
Title or Position: OFFICE OPERATIONS MANAGER
Credential:
Phone: 703-726-4092