Provider Demographics
NPI:1073508412
Name:SOUND LIMBS ORTHOTICS, INC.
Entity Type:Organization
Organization Name:SOUND LIMBS ORTHOTICS, INC.
Other - Org Name:SOUND LIMBS ORTHOTICS & PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:D
Authorized Official - Last Name:PARK
Authorized Official - Suffix:JR
Authorized Official - Credentials:CO
Authorized Official - Phone:207-784-4345
Mailing Address - Street 1:39 S LISBON RD
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-1404
Mailing Address - Country:US
Mailing Address - Phone:207-784-4345
Mailing Address - Fax:207-783-9496
Practice Address - Street 1:39 S LISBON RD
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-1404
Practice Address - Country:US
Practice Address - Phone:207-784-4345
Practice Address - Fax:207-783-9496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME126940000Medicaid
ME126940000Medicaid