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General NPI Number Information
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NPI Number | 1861872269
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Entity Type | Organization
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Legal Business Name | ORTHOPRO OF TWIN FALLS, INC.
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Dates
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Enumeration Date | 06/02/2015
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Last Update Date | 01/07/2021
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Provider Practice Location Address
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Address Line | 1600 OVERLAND AVE STE C
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City | BURLEY
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State | ID
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Zip | 83318-2434
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Country | US
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Telephone | 877-733-0505
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Fax |
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Provider Business Mailing Address
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Address Line | 1437 PARK VIEW DR STE 200
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City | TWIN FALLS
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State | ID
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Zip | 83301-4167
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Country | US
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Telephone | 208-733-0505
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHAEL SCOTT JOHNSON
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Credential | CPO
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Telephone | 208-733-0505
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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 | DME236
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License Number State | ID
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