Provider Demographics
NPI:1326323031
Name:CAPITAL ORTHOTICS AND PROSTHETICS TECHNOLOGIES, LLC
Entity Type:Organization
Organization Name:CAPITAL ORTHOTICS AND PROSTHETICS TECHNOLOGIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARTER
Authorized Official - Middle Name:PRESTON
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:804-425-9507
Mailing Address - Street 1:1500 HUGUENOT RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2478
Mailing Address - Country:US
Mailing Address - Phone:804-378-4902
Mailing Address - Fax:804-378-4904
Practice Address - Street 1:1500 HUGUENOT RD
Practice Address - Street 2:SUITE 106
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2478
Practice Address - Country:US
Practice Address - Phone:804-378-4902
Practice Address - Fax:804-378-4904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-13
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier