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General NPI Number Information
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NPI Number | 1720211949
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Entity Type | Organization
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Legal Business Name | LIFECARE PROSTHETICS AND ORTHOTICS PLLC
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Dates
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Enumeration Date | 09/03/2009
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Last Update Date | 02/10/2012
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Provider Practice Location Address
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Address Line | 212 N MAIN ST
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City | DUNCANVILLE
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State | TX
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Zip | 75116-3649
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Country | US
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Telephone | 972-298-0018
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Fax | 972-298-0019
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Provider Business Mailing Address
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Address Line | 212 N MAIN ST
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City | DUNCANVILLE
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State | TX
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Zip | 75116-3649
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Country | US
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Telephone | 972-298-0018
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Fax | 972-298-0019
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MRS. DEANNA P WILLIAMS
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Credential | L.P.O., C.O.
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Telephone | 972-298-0018
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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 | 101313
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License Number State | TX
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