MEDICARE: PROSTHETIC ONE

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	1829	TX

General Provider Information

NPI Number	:	1891232617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSTHETIC ONE

Provider Business Mailing Address
First Line	:	3125 MATLOCK RD STE 100
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76015-2905
Country	:	US
Telephone Number	:	682-323-5921
Fax Number	:	682-323-5974

Provider Business Practice Location Address
First Line	:	3050 S CENTER ST STE 120
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76014-2154
Country	:	US
Telephone Number	:	682-323-5921
Fax Number	:	682-323-5974

Authorized Official
Title or Position	:	CEO
Name	:	MR. MARCUS BAKER
Credential	:	CPO/L
Telephone Number	:	682-323-5921

Provider Enumeration Date	:	01/31/2017
Last Update Date	:	01/24/2025

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Directions to “PROSTHETIC ONE ” Practice Location

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