MEDICARE: PHILADELPHIA ORTHOTICS AND PROSTHETICS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1194785741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILADELPHIA ORTHOTICS AND PROSTHETICS, INC.

Provider Business Mailing Address
First Line	:	301 S 8TH ST
Second Line	:	STE B2
City	:	PHILADELPHIA
State	:	PA
Zip	:	19106-4000
Country	:	US
Telephone Number	:	215-829-5733
Fax Number	:	215-829-5772

Provider Business Practice Location Address
First Line	:	301 S 8TH ST
Second Line	:	STE B2
City	:	PHILADELPHIA
State	:	PA
Zip	:	19106-4000
Country	:	US
Telephone Number	:	215-829-5733
Fax Number	:	215-829-5772

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MR. WILLIAM PENNEY
Credential	:	CPO/LPO
Telephone Number	:	215-829-5733

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	02/07/2020

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