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General NPI Number Information
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NPI Number | 1992703201
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Entity Type | Organization
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Legal Business Name | NORTHWEST ORTHOTICS PROSTHETICS INC
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Dates
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Enumeration Date | 07/11/2005
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Last Update Date | 01/20/2023
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Provider Practice Location Address
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Address Line | 39830 GRAND RIVER AVE SUITE B1D
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City | NOVI
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State | MI
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Zip | 48375-2140
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Country | US
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Telephone | 248-477-1443
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Fax | 248-477-1509
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Provider Business Mailing Address
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Address Line | 39830 GRAND RIVER AVE SUITE B1D
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City | NOVI
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State | MI
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Zip | 48375-2140
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Country | US
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Telephone | 248-477-1443
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Fax | 248-477-1509
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Authorized Official
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Title or Position | GENERAL MANAGER, CERTIFIED PROSTHE
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Name | MR. GREG V GREENWAY
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Credential | CP
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Telephone | 248-477-1443
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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 | B ME 0149837
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License Number State | MI
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