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General NPI Number Information
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NPI Number | 1063930246
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Entity Type | Organization
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Legal Business Name | VAN DER WATT PROSTHETICS & ORTHOTICS
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Dates
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Enumeration Date | 09/07/2017
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Last Update Date | 09/07/2017
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Provider Practice Location Address
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Address Line | 11 N. MAIN ST.
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City | GREENWOOD
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State | AR
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Zip | 72936
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Country | US
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Telephone | 479-357-1840
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Fax | 479-357-1839
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Provider Business Mailing Address
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Address Line | PO BOX 843
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City | GREENWOOD
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State | AR
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Zip | 72936-0843
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Country | US
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Telephone | 479-357-1840
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Fax | 479-357-1839
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Authorized Official
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Title or Position | OWNER
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Name | MR. FRANCOIS J VAN DER WATT
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Credential | CPO
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Telephone | 479-357-1840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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