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General NPI Number Information
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NPI Number | 1780303883
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Entity Type | Organization
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Legal Business Name | DURRETT'S ORTHOTIC AND PROSTHETIC LLC
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Dates
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Enumeration Date | 08/23/2022
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 1049 W EADS PKWY
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City | LAWRENCEBURG
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State | IN
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Zip | 47025-1162
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Country | US
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Telephone | 812-489-7304
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Fax | 812-489-7320
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Provider Business Mailing Address
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Address Line | 20 MEDICAL VILLAGE DR STE 100
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City | EDGEWOOD
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State | KY
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Zip | 41017-5403
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Country | US
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Telephone | 859-341-7688
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SUZANNE WARD
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Credential |
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Telephone | 859-341-7688
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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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