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General NPI Number Information
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NPI Number | 1083701940
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Entity Type | Organization
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Legal Business Name | LETOURNEAU LIFELIKE ORTHOTICS & PROSTHETICS, INC.
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 02/23/2017
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Provider Practice Location Address
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Address Line | 2051 SOUTH WHEELER STE D
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City | JASPER
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State | TX
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Zip | 75951
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Country | US
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Telephone | 409-832-5005
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Fax | 409-832-5015
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Provider Business Mailing Address
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Address Line | PO BOX 21698
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City | BEAUMONT
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State | TX
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Zip | 77720
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Country | US
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Telephone | 409-832-5005
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Fax | 409-832-5015
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Authorized Official
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Title or Position | CFO, SECRETARY, TREASURER
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Name | SANDRA LETOURNEAU
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Credential |
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Telephone | 409-832-5005
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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 | 101506
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License Number State | TX
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