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General NPI Number Information
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NPI Number | 1316198682
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Entity Type | Organization
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Legal Business Name | PROSTHETIC ORTHOTIC CENTER
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Dates
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Enumeration Date | 10/06/2008
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Last Update Date | 07/03/2012
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Provider Practice Location Address
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Address Line | 9815 HWY 70 STE 101
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City | MINOCQUA
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State | WI
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Zip | 54548-9769
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Country | US
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Telephone | 715-356-3377
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Fax | 715-845-6310
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Provider Business Mailing Address
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Address Line | 1108 S 17TH AVE
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City | WAUSAU
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State | WI
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Zip | 54401-5709
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Country | US
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Telephone | 715-845-2800
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Fax | 715-845-2855
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT KARL LOTZ
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Credential | CPO, FAAOP
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Telephone | 715-432-7787
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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 |
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