=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841604469
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROSTHETIC CONSULTING TECHNOLOGIES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2014
-----------------------------------------------------
Last Update Date | 12/01/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 328 E WINNIE LN
-----------------------------------------------------
City | CARSON CITY
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89706-2256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-467-3218
-----------------------------------------------------
Fax | 775-467-3219
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 220 US HIGHWAY 395 N
-----------------------------------------------------
City | CARSON CITY
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89704-9545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-849-0958
-----------------------------------------------------
Fax | 775-849-2566
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CP
-----------------------------------------------------
Name | MR. RICHARD LEE RILEY
-----------------------------------------------------
Credential | CP
-----------------------------------------------------
Telephone | 775-467-3218
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------