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General NPI Number Information
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NPI Number | 1093870743
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Entity Type | Organization
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Legal Business Name | PEDORTHIC TECHNOLOGIES INC
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Dates
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Enumeration Date | 12/23/2006
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Last Update Date | 11/12/2021
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Provider Practice Location Address
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Address Line | 285 PARK AVE
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City | CRANSTON
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State | RI
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Zip | 02905-1241
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Country | US
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Telephone | 401-780-0590
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Fax | 401-780-0591
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Provider Business Mailing Address
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Address Line | 285 PARK AVE
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City | CRANSTON
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State | RI
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Zip | 02905-1241
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Country | US
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Telephone | 401-780-0590
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Fax | 401-780-0591
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | ERIC PALMER
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Credential |
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Telephone | 401-780-0590
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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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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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