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General NPI Number Information
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NPI Number | 1588650337
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Entity Type | Organization
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Legal Business Name | NEW LIFE PROSTHETICS AND ORTHOTICS
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Dates
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Enumeration Date | 09/26/2005
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Last Update Date | 04/23/2012
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Provider Practice Location Address
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Address Line | 2013 WELLS BRANCH PKWY STE 207
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City | AUSTIN
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State | TX
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Zip | 78728-6900
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Country | US
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Telephone | 512-252-7177
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Fax | 512-252-7156
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Provider Business Mailing Address
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Address Line | 2013 WELLS BRANCH PKWY STE 207
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City | AUSTIN
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State | TX
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Zip | 78728-6900
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Country | US
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Telephone | 512-252-7177
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Fax | 512-252-7156
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Authorized Official
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Title or Position | ORTHOTIST PROSTHETIST MANAGER
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Name | MR. SCOTT BOWDEN ATHA
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Credential | LPO
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Telephone | 512-252-7177
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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 | 2
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License Number State | TX
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