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General NPI Number Information
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NPI Number | 1972588143
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Entity Type | Organization
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Legal Business Name | SNELL PROSTHETIC & ORTHOTIC LABORATORY
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Dates
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Enumeration Date | 12/10/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 900 PROFESSIONAL ACRES DR
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City | JONESBORO
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State | AR
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Zip | 72401-4321
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Country | US
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Telephone | 870-268-0001
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Fax | 870-875-9081
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Provider Business Mailing Address
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Address Line | 625 N UNIVERSITY AVE
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City | LITTLE ROCK
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State | AR
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Zip | 72205-2917
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Country | US
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Telephone | 501-664-2624
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Fax | 501-664-1708
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | RICK FLEETWOOD
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Credential |
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Telephone | 501-664-2624
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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 | 04734178001
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License Number State | AR
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