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General NPI Number Information
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NPI Number | 1407263148
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Entity Type | Organization
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Legal Business Name | ARCH RIVALS ORTHOTICS LLC
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Dates
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Enumeration Date | 07/15/2014
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Last Update Date | 07/28/2014
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Provider Practice Location Address
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Address Line | 601 E GENERAL STEWART WAY
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City | HINESVILLE
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State | GA
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Zip | 31313-2627
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Country | US
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Telephone | 912-355-4557
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Fax |
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Provider Business Mailing Address
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Address Line | 875 WARNELL DR
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City | RICHMOND HILL
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State | GA
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Zip | 31324-4823
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Country | US
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Telephone | 912-355-4557
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MELISSA ROBITAILLE
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Credential |
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Telephone | 912-355-4557
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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 | 4621650
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License Number State | GA
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