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General NPI Number Information
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NPI Number | 1295959492
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Entity Type | Organization
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Legal Business Name | PROSTHETICARE FORT WORTH LP
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 06/12/2024
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Provider Practice Location Address
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Address Line | 7241 HAWKINS VIEW DR
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City | FORT WORTH
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State | TX
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Zip | 76132-3921
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Country | US
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Telephone | 817-336-8293
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Fax | 817-336-9017
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Provider Business Mailing Address
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Address Line | 7241 HAWKINS VIEW DR
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City | FORT WORTH
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State | TX
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Zip | 76132-3921
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Country | US
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Telephone | 817-336-8293
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Fax | 817-336-9017
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Authorized Official
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Title or Position | CEO
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Name | MR. JUSTIN JENKINS
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Credential |
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Telephone | 903-571-5631
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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 | 10128
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License Number State | TX
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