Provider Demographics
NPI:1225628670
Name:COMPLETE CARE PROSTHETICS AND ORTHOTICS LLC
Entity Type:Organization
Organization Name:COMPLETE CARE PROSTHETICS AND ORTHOTICS LLC
Other - Org Name:COMPLETE CARE PROSTHETICS AND ORTHOTICS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROSTHETIST/ORTHOTIST
Authorized Official - Prefix:
Authorized Official - First Name:ABIODUN
Authorized Official - Middle Name:OLUWAGBENGA
Authorized Official - Last Name:SOBOWALE
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:215-298-0604
Mailing Address - Street 1:600 WASHINGTON AVE STE 18UC
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-4836
Mailing Address - Country:US
Mailing Address - Phone:215-298-0604
Mailing Address - Fax:215-298-0608
Practice Address - Street 1:600 WASHINGTON AVE STE 18UC
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-4836
Practice Address - Country:US
Practice Address - Phone:215-298-0604
Practice Address - Fax:215-298-0608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty