MEDICARE: LONE STAR PROSTHETICS, WICHITA FALLS, 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

General Provider Information

NPI Number	:	1619752789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONE STAR PROSTHETICS, WICHITA FALLS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 200402
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-0402
Country	:	US
Telephone Number	:	940-285-5100
Fax Number	:

Provider Business Practice Location Address
First Line	:	4020 RHEA RD STE 5D
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-2739
Country	:	US
Telephone Number	:	940-285-5100
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PROSTHETIST
Name	:	BRYAN PETTIT
Credential	:	LP
Telephone Number	:	940-285-5100

Provider Enumeration Date	:	08/28/2023
Last Update Date	:	07/27/2025

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