Provider Demographics
NPI:1326483264
Name:PROSTHETIC SPECIALTIES LLC
Entity Type:Organization
Organization Name:PROSTHETIC SPECIALTIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRET
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:RECKINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-607-3372
Mailing Address - Street 1:13143 LAKE PLACE RD
Mailing Address - Street 2:
Mailing Address - City:ZIMMERMAN
Mailing Address - State:MN
Mailing Address - Zip Code:55398-9567
Mailing Address - Country:US
Mailing Address - Phone:763-607-3372
Mailing Address - Fax:
Practice Address - Street 1:13143 LAKE PLACE RD
Practice Address - Street 2:
Practice Address - City:ZIMMERMAN
Practice Address - State:MN
Practice Address - Zip Code:55398-9567
Practice Address - Country:US
Practice Address - Phone:763-607-3372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier