Healthcare Provider Details

I. General information

NPI: 1932309747
Provider Name (Legal Business Name): CENTER FOR PROSTHETICS ORTHOTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 12TH AVE
SEATTLE WA
98122-5577
US

IV. Provider business mailing address

411 12TH AVE
SEATTLE WA
98122-5577
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number0100000027
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberPS00000026
License Number StateWA

VIII. Authorized Official

Name: MR. DAVID VARNAU
Title or Position: PRESIDENT
Credential: C.P.O., L.P.O.
Phone: 206-328-4276