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General NPI Number Information
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NPI Number | 1306953930
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Entity Type | Organization
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Legal Business Name | BUFFALO ORTHOTICS & PROSTHETICS, INC.
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 112 1ST ST S
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City | BUFFALO
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State | MN
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Zip | 55313-1402
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Country | US
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Telephone | 763-684-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 112 1ST ST S
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City | BUFFALO
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State | MN
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Zip | 55313-1402
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Country | US
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Telephone | 763-684-1800
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Fax |
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Authorized Official
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Title or Position | ORTHOTIST/OWNER
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Name | DANNY BRUCE HUSOM
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Credential | C.PED., C.O., OST
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Telephone | 763-684-1800
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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 |
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License Number State | MN
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