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General NPI Number Information
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NPI Number | 1851364764
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Entity Type | Organization
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Legal Business Name | LIFESTYLE PROSTHETICS & ORTHOTICS, INC.
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Dates
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Enumeration Date | 02/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 27 CHARLES ST
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City | NORTH ANDOVER
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State | MA
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Zip | 01845-1664
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Country | US
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Telephone | 978-688-7900
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Fax | 978-688-7938
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Provider Business Mailing Address
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Address Line | 27 CHARLES ST
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City | NORTH ANDOVER
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State | MA
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Zip | 01845-1664
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Country | US
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Telephone | 978-688-7900
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Fax | 978-688-7938
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT EMERSON
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Credential | CP
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Telephone | 978-688-7900
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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 | TA1E3F96683073
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License Number State | MA
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