MEDICARE: KICKSTART ORTHOTICS AND PROSTHETICS, PLLC

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	:	1427731314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KICKSTART ORTHOTICS AND PROSTHETICS, PLLC

Provider Business Mailing Address
First Line	:	1120 N PINES RD STE C
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-4942
Country	:	US
Telephone Number	:	509-795-1007
Fax Number	:	509-795-1008

Provider Business Practice Location Address
First Line	:	1120 N PINES RD STE C
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-4942
Country	:	US
Telephone Number	:	509-795-1007
Fax Number	:	509-795-1008

Authorized Official
Title or Position	:	MEMBER
Name	:	PETER SPRINGS
Credential	:	CPO
Telephone Number	:	509-359-5329

Provider Enumeration Date	:	08/08/2023
Last Update Date	:	08/08/2023

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