MEDICARE: LEVERAGE O&P, LLC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	222Z00000X	Orthotist
2	224P00000X	Prosthetist
3	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1205301728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEVERAGE O&P, LLC.

Provider Business Mailing Address
First Line	:	7208 WOODROW DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-8207
Country	:	US
Telephone Number	:	970-372-1273
Fax Number	:	970-797-1865

Provider Business Practice Location Address
First Line	:	7208 WOODROW DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-8207
Country	:	US
Telephone Number	:	970-372-1273
Fax Number	:	970-797-1865

Authorized Official
Title or Position	:	OWNER/ CERTIFIED ORTHOTIST, PEDORTH
Name	:	CRAIG HENRY
Credential	:	B.O.C.O, B.O.CPED
Telephone Number	:	970-372-1273

Provider Enumeration Date	:	10/11/2018
Last Update Date	:	10/14/2018

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