Provider Demographics
NPI:1346771029
Name:STRIDE PROSTHETICS LLC
Entity Type:Organization
Organization Name:STRIDE PROSTHETICS LLC
Other - Org Name:STRIDE PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:BOCP, LP
Authorized Official - Phone:606-585-4996
Mailing Address - Street 1:PO BOX 611
Mailing Address - Street 2:
Mailing Address - City:FLATWOODS
Mailing Address - State:KY
Mailing Address - Zip Code:41139-0611
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6319 E US HIGHWAY 36 STE 203
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6210
Practice Address - Country:US
Practice Address - Phone:317-526-4700
Practice Address - Fax:888-508-6271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-23
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier