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General NPI Number Information
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NPI Number | 1285821637
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Entity Type | Organization
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Legal Business Name | ORTHO REHAB DESIGNS PROSTHETICS AND ORTHOTICS, INC.
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 01/12/2012
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Provider Practice Location Address
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Address Line | 2578 BELCASTRO ST SUITE 101
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City | LAS VEGAS
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State | NV
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Zip | 89117-3067
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Country | US
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Telephone | 702-388-9909
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Fax | 702-388-9929
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Provider Business Mailing Address
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Address Line | 2578 BELCASTRO ST SUITE 101
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City | LAS VEGAS
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State | NV
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Zip | 89117-3067
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Country | US
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Telephone | 702-388-9909
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Fax | 702-388-9929
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. MITCHELL S. WARNER
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Credential | CPO
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Telephone | 702-388-9909
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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 | MP00102
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License Number State | NV
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