Provider Demographics
NPI:1326599812
Name:CERTIFIED PROSTHETICS & ORTHOTICS, LLC
Entity Type:Organization
Organization Name:CERTIFIED PROSTHETICS & ORTHOTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BRADSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-565-3485
Mailing Address - Street 1:8101 E LOWRY BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7196
Mailing Address - Country:US
Mailing Address - Phone:303-565-3485
Mailing Address - Fax:303-532-5140
Practice Address - Street 1:1620 25TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4960
Practice Address - Country:US
Practice Address - Phone:970-356-2123
Practice Address - Fax:970-352-4943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO042520280000335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier