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General NPI Number Information
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NPI Number | 1689268369
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Entity Type | Organization
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Legal Business Name | BOLT ONS
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Dates
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Enumeration Date | 02/23/2021
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Last Update Date | 10/11/2023
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Provider Practice Location Address
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Address Line | 123 W. BIRCH AVE STE 100
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City | FLAGSTAFF
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State | AZ
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Zip | 86001
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Country | US
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Telephone | 928-772-5777
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Fax | 928-271-8459
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Provider Business Mailing Address
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Address Line | 123 BIRCH AVE SUITE 100
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City | FLAGSTAFF
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State | AZ
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Zip | 86001
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Country | US
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Telephone | 928-772-5777
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Fax | 928-271-8459
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Authorized Official
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Title or Position | CLINICIAN/OWNER
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Name | MICHAEL KAYSER
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Credential | CPO
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Telephone | 928-255-8665
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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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