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General NPI Number Information
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NPI Number | 1700832227
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Entity Type | Organization
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Legal Business Name | PROSTHETIC & ORTHOTIC GROUP OF NORTHERN CO., LLC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 2290 E PROSPECT RD SUITE 2
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City | FORT COLLINS
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State | CO
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Zip | 80525-9768
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Country | US
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Telephone | 970-416-9357
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Fax | 970-416-9359
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Provider Business Mailing Address
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Address Line | 2290 E PROSPECT RD STE 2
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City | FORT COLLINS
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State | CO
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Zip | 80525-9768
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Country | US
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Telephone | 970-416-9357
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Fax | 970-416-9359
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Authorized Official
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Title or Position | MEMBER
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Name | MR. GLENN MATSUSHIMA
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Credential |
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Telephone | 562-595-6445
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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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