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General NPI Number Information
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NPI Number | 1578403101
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Entity Type | Organization
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Legal Business Name | SRT PROSTHETICS & ORTHOTICS LLC
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Dates
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Enumeration Date | 04/01/2026
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Last Update Date | 04/01/2026
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Provider Practice Location Address
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Address Line | 3802 AMELIA AVE STE B
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City | LAFAYETTE
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State | IN
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Zip | 47905-5772
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Country | US
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Telephone | 317-296-7330
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Fax |
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Provider Business Mailing Address
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Address Line | 102 WOODMONT BLVD STE 400
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City | NASHVILLE
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State | TN
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Zip | 37205-5217
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIR OF FINANCE
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Name | BRADFORD GARDNER
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Credential |
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Telephone | 615-864-8783
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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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