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General NPI Number Information
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NPI Number | 1194051383
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Entity Type | Organization
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Legal Business Name | B&L PROSTHETICS
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Dates
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Enumeration Date | 10/23/2009
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Last Update Date | 06/25/2019
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Provider Practice Location Address
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Address Line | 704 GASLIGHT BLVD
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City | LUFKIN
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State | TX
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Zip | 75904-3153
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Country | US
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Telephone | 936-634-0013
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Fax | 936-634-0015
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Provider Business Mailing Address
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Address Line | 704 GASLIGHT BLVD
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City | LUFKIN
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State | TX
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Zip | 75904-3153
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Country | US
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Telephone | 936-634-0013
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Fax | 936-634-0015
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Authorized Official
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Title or Position | OWNER
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Name | MR. BROOKS RYAN RANEY
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Credential | CP
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Telephone | 936-634-0013
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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 | 1418
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License Number State | TX
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