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General NPI Number Information
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NPI Number | 1275560518
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Entity Type | Organization
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Legal Business Name | LIFE IN MOTION ORTHOTIC & PROSTHETIC CENTER, INC.
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 443 N SAINT FRANCIS AVE STE E
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City | WICHITA
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State | KS
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Zip | 67202-2629
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Country | US
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Telephone | 316-640-7267
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Fax | 620-225-0102
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Provider Business Mailing Address
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Address Line | PO BOX 55
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City | WICHITA
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State | KS
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Zip | 67201-0055
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Country | US
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Telephone | 316-640-7267
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Fax | 620-225-0102
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Authorized Official
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Title or Position | PRESIDENT, O & P PRACTICIONER
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Name | MR. MICHAEL A ROLLE
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Credential | ABC CERTIFIED CP2919
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Telephone | 316-640-7267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number | 036F01
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License Number State | KS
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