MEDICARE: PROSTHETIC INNOVATIONS, LLC

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	6000006880	PA

General Provider Information

NPI Number	:	1205878535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSTHETIC INNOVATIONS, LLC

Provider Business Mailing Address
First Line	:	1400 INDUSTRIAL HWY
Second Line	:
City	:	EDDYSTONE
State	:	PA
Zip	:	19022-1522
Country	:	US
Telephone Number	:	610-447-8777
Fax Number	:	610-447-0932

Provider Business Practice Location Address
First Line	:	1400 INDUSTRIAL HWY
Second Line	:
City	:	EDDYSTONE
State	:	PA
Zip	:	19022-1522
Country	:	US
Telephone Number	:	610-447-8777
Fax Number	:	610-447-0932

Authorized Official
Title or Position	:	PARTNER
Name	:	TIMOTHY RAYER
Credential	:	CP
Telephone Number	:	610-447-8777

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	12/14/2017

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