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General NPI Number Information
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NPI Number | 1528304649
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Entity Type | Organization
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Legal Business Name | THE PROGRESSIVE ORTHOPAEDIC COMPANY,LLC
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Dates
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Enumeration Date | 12/18/2012
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Last Update Date | 12/18/2012
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Provider Practice Location Address
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Address Line | 1000 HAMPTON CTR SUITE D
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City | MORGANTOWN
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State | WV
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Zip | 26505-3315
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Country | US
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Telephone | 304-777-4789
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Fax | 304-777-4790
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Provider Business Mailing Address
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Address Line | 1000 HAMPTON CTR SUITE D
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City | MORGANTOWN
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State | WV
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Zip | 26505-3315
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Country | US
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Telephone | 304-777-4789
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Fax | 304-777-4790
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. THOMAS BRADLEY HARRIS
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Credential |
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Telephone | 304-777-4789
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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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