Provider Demographics
NPI:1225501752
Name:ADAPTIVE PROSTHETICS AND ORTHOTICS LLC
Entity Type:Organization
Organization Name:ADAPTIVE PROSTHETICS AND ORTHOTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-580-4688
Mailing Address - Street 1:808 BELANGER ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4408
Mailing Address - Country:US
Mailing Address - Phone:985-580-4688
Mailing Address - Fax:
Practice Address - Street 1:1208 LOUISE ST
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4257
Practice Address - Country:US
Practice Address - Phone:985-316-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADAPTIVE PROSTHETICS AND ORTHOTICS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier