Healthcare Provider Details

I. General information

NPI: 1013980820
Provider Name (Legal Business Name): CENTER FOR PROSTHETICS ORTHOTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 116TH AVE NE STE 725 SUITE 725
BELLEVUE WA
98004-3804
US

IV. Provider business mailing address

411 12TH AVE
SEATTLE WA
98122-5577
US

V. Phone/Fax

Practice location:
  • Phone: 425-454-4276
  • Fax: 425-454-3445
Mailing address:
  • Phone: 206-328-4276
  • Fax: 206-328-1037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberPS00000002
License Number StateWA

VIII. Authorized Official

Name: JOSE IGNACIO
Title or Position: OWNER
Credential: CPO
Phone: 206-328-4276