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General NPI Number Information
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NPI Number | 1932446812
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Entity Type | Organization
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Legal Business Name | PROSTHETIX SHOP LLC
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Dates
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Enumeration Date | 01/11/2013
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Last Update Date | 03/29/2022
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Provider Practice Location Address
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Address Line | 431 OHIO PIKE SUITE 124 SOUTH
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City | CINCINNATI
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State | OH
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Zip | 45255-3375
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Country | US
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Telephone | 513-843-5126
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Fax | 513-843-5164
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Provider Business Mailing Address
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Address Line | 431 OHIO PIKE SUITE 124 SOUTH
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City | CINCINNATI
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State | OH
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Zip | 45255-3375
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Country | US
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Telephone | 513-843-5126
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Fax | 513-843-5164
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Authorized Official
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Title or Position | OWNER
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Name | AARON MOLES
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Credential | LP
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Telephone | 513-843-5126
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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 | 304
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License Number State | OH
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