Provider Demographics
NPI:1073140414
Name:PHOENIX RISING PROSTHETIC ORTHOTIC SERVICE PLLC
Entity Type:Organization
Organization Name:PHOENIX RISING PROSTHETIC ORTHOTIC SERVICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPO/LPO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SCHECHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-865-1270
Mailing Address - Street 1:PO BOX 1535
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60078-1535
Mailing Address - Country:US
Mailing Address - Phone:847-865-1270
Mailing Address - Fax:847-865-1272
Practice Address - Street 1:330 W COLFAX ST STE 100
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-2538
Practice Address - Country:US
Practice Address - Phone:847-865-1270
Practice Address - Fax:847-865-1272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-25
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty