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General NPI Number Information
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NPI Number | 1427427913
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Entity Type | Organization
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Legal Business Name | LIFE IN MOTION ORTHOTIC & PROSTHETIC CENTER, INC.
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Dates
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Enumeration Date | 09/15/2015
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Last Update Date | 11/22/2019
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Provider Practice Location Address
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Address Line | 2601 CENTRAL AVE STE 22
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City | DODGE CITY
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State | KS
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Zip | 67801-2606
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Country | US
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Telephone | 620-225-0113
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Fax | 620-225-0102
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Provider Business Mailing Address
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Address Line | 2601 CENTRAL AVE STE 22
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City | DODGE CITY
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State | KS
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Zip | 67801-2606
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Country | US
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Telephone | 620-225-0113
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Fax | 620-225-0102
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL A ROLLE
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Credential | ABC /BOC/BS
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Telephone | 316-640-7267
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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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