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General NPI Number Information
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NPI Number | 1750588505
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Entity Type | Organization
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Legal Business Name | PRINCE WILLIAM ORTHOTICS & PROSTHETICS LLC
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 03/22/2019
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Provider Practice Location Address
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Address Line | 10322 BATTLEVIEW PKWY
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City | MANASSAS
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State | VA
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Zip | 20109-2338
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Country | US
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Telephone | 703-368-7967
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Fax | 703-368-7867
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Provider Business Mailing Address
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Address Line | 10322 BATTLEVIEW PKWY
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City | MANASSAS
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State | VA
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Zip | 20109-2338
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Country | US
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Telephone | 703-368-7967
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Fax | 703-368-7867
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. ALBERT J. GARNEY
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Credential | CPO
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Telephone | 703-386-7967
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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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