MEDICARE: PROFESSIONAL PROSTHETICS & ORTHOTICS, 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	LP0378	TX

General Provider Information

NPI Number	:	1295950418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL PROSTHETICS & ORTHOTICS, INC.

Provider Business Mailing Address
First Line	:	8637 FREDERICKSBURG RD STE 131
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1283
Country	:	US
Telephone Number	:	210-690-0739
Fax Number	:	210-690-2179

Provider Business Practice Location Address
First Line	:	8637 FREDERICKSBURG RD STE 131
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1283
Country	:	US
Telephone Number	:	210-690-0739
Fax Number	:	210-690-2179

Authorized Official
Title or Position	:	OWNER, PRESIDENT
Name	:	JAMES MCCOY
Credential	:	C.P., L.P., FAAOP
Telephone Number	:	210-690-0739

Provider Enumeration Date	:	04/14/2007
Last Update Date	:	08/22/2020

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