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General NPI Number Information
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NPI Number | 1831546381
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Entity Type | Organization
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Legal Business Name | EXTENSIONU LLC
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Dates
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Enumeration Date | 05/14/2016
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Last Update Date | 05/14/2016
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Provider Practice Location Address
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Address Line | 5168 OSCEOLA DR
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City | DAYTON
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State | OH
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Zip | 45417-8215
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Country | US
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Telephone | 937-867-8155
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Fax | 513-351-2650
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Provider Business Mailing Address
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Address Line | 5168 OSCEOLA DR
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City | DAYTON
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State | OH
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Zip | 45417-8215
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Country | US
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Telephone |
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Fax | 513-351-2650
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Authorized Official
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Title or Position | OWNER
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Name | MS. ANGELA WADE
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Credential |
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Telephone | 937-867-8155
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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 | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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