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General NPI Number Information
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NPI Number | 1891232617
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Entity Type | Organization
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Legal Business Name | PROSTHETIC ONE
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Dates
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Enumeration Date | 01/31/2017
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 3050 S CENTER ST STE 120
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City | ARLINGTON
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State | TX
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Zip | 76014-2154
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Country | US
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Telephone | 682-323-5921
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Fax | 682-323-5974
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Provider Business Mailing Address
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Address Line | 3125 MATLOCK RD STE 100
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City | ARLINGTON
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State | TX
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Zip | 76015-2905
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Country | US
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Telephone | 682-323-5921
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Fax | 682-323-5974
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Authorized Official
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Title or Position | CEO
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Name | MR. MARCUS BAKER
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Credential | CPO/L
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Telephone | 682-323-5921
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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 | 1829
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License Number State | TX
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