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General NPI Number Information
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NPI Number | 1619752789
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Entity Type | Organization
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Legal Business Name | LONE STAR PROSTHETICS, WICHITA FALLS, LLC
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Dates
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Enumeration Date | 08/28/2023
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Last Update Date | 07/27/2025
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Provider Practice Location Address
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Address Line | 4020 RHEA RD STE 5D
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City | WICHITA FALLS
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State | TX
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Zip | 76308-2739
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Country | US
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Telephone | 940-285-5100
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 200402
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City | ARLINGTON
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State | TX
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Zip | 76006-0402
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Country | US
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Telephone | 940-285-5100
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Fax |
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Authorized Official
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Title or Position | LICENSED PROSTHETIST
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Name | BRYAN PETTIT
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Credential | LP
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Telephone | 940-285-5100
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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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