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General NPI Number Information
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NPI Number | 1689706053
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Entity Type | Organization
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Legal Business Name | ORTHOPRO OF TWIN FALLS, INC
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 01/07/2021
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Provider Practice Location Address
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Address Line | 1437 PARKVIEW DR STE 200
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City | TWIN FALLS
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State | ID
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Zip | 83301-4167
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Country | US
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Telephone | 208-733-0505
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Fax | 208-735-2117
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Provider Business Mailing Address
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Address Line | 1437 PARKVIEW DR STE 200
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City | TWIN FALLS
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State | ID
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Zip | 83301-4167
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Country | US
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Telephone | 208-733-0505
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Fax | 208-735-2117
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Authorized Official
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Title or Position | OWNER/CPO
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Name | MICHAEL SCOTT JOHNSON
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Credential |
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Telephone | 208-733-0505
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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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Taxonomy #2
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number |
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License Number State |
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