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General NPI Number Information
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NPI Number | 1427231612
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Entity Type | Organization
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Legal Business Name | NEW LIFE PROSTHETICS CORPORATION
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 08/25/2008
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Provider Practice Location Address
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Address Line | 87 NELMS RD
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City | GRAYSVILLE
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State | TN
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Zip | 37338-4632
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Country | US
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Telephone | 423-949-8620
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Fax | 423-949-9217
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Provider Business Mailing Address
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Address Line | 87 NELMS RD
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City | GRAYSVILLE
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State | TN
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Zip | 37338-4632
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Country | US
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Telephone | 423-949-8620
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Fax |
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Authorized Official
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Title or Position | CERTIFIED PROSTHETIST/OWNER
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Name | MR. ROGER TERRY COOK
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Credential | CP
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Telephone | 423-949-8620
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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 | PRO0000000083
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License Number State | TN
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