Provider Demographics
NPI:1104177401
Name:ORTHOTIC CARE LLC
Entity Type:Organization
Organization Name:ORTHOTIC CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-609-0122
Mailing Address - Street 1:4837 TAYLORSVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NC
Mailing Address - Zip Code:28678-9050
Mailing Address - Country:US
Mailing Address - Phone:215-949-3636
Mailing Address - Fax:267-522-8364
Practice Address - Street 1:4837 TAYLORSVILLE HWY
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NC
Practice Address - Zip Code:28678-9050
Practice Address - Country:US
Practice Address - Phone:215-949-3636
Practice Address - Fax:267-522-8364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6762720001Medicare NSC