Provider Demographics
NPI:1043280779
Name:GAITWELL ORTHOTICS AND PEDORTHICS
Entity Type:Organization
Organization Name:GAITWELL ORTHOTICS AND PEDORTHICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANANGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-456-4800
Mailing Address - Street 1:1 N COMMERCE PARK DR STE 306
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-3188
Mailing Address - Country:US
Mailing Address - Phone:513-829-2217
Mailing Address - Fax:513-889-1850
Practice Address - Street 1:560 S LOOP RD
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3405
Practice Address - Country:US
Practice Address - Phone:859-301-0622
Practice Address - Fax:513-889-1850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90006024Medicaid
KY0OtherSTRATOSE
KY106156400OtherACS WORKERS COMP
KYA146596OtherMULTI PLAN
KY0OtherHEALTHSMART NETWORK
KY000000298877OtherANTHEM BLUE CROSS
KY=========OtherHEALTHSPAN
KY=========OtherCHA HEALTH HUMANA
KYA146596OtherMULTI PLAN
KY0OtherSTRATOSE
KY000000298877OtherANTHEM BLUE CROSS
KY106156400OtherACS WORKERS COMP
KYA146596OtherMULTI PLAN