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General NPI Number Information
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NPI Number | 1295209484
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Entity Type | Organization
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Legal Business Name | SUNRISE ORTHOTICS & PROSTHETICS, LLC
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Dates
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Enumeration Date | 01/22/2019
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Last Update Date | 01/25/2019
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Provider Practice Location Address
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Address Line | 27 TECHNOLOGY WAY STE 2E6
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City | NASHUA
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State | NH
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Zip | 03060-3245
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Country | US
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Telephone | 603-854-8094
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Fax | 603-389-6007
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Provider Business Mailing Address
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Address Line | 35 WOODFIELD ST
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City | NASHUA
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State | NH
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Zip | 03062-2066
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Country | US
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Telephone | 603-891-1648
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | NATHANIEL SMILEY
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Credential | COA
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Telephone | 603-854-8094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Z00000X
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Taxonomy Name | Orthotist
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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 | 224P00000X
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Taxonomy Name | Prosthetist
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License Number |
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License Number State |
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Taxonomy #3
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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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