Provider Demographics
NPI:1376006734
Name:DAVID ROTTER PROSTHETICS, LTD
Entity Type:Organization
Organization Name:DAVID ROTTER PROSTHETICS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROTTER
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:815-714-2932
Mailing Address - Street 1:121 SPRINGFIELD AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6545
Mailing Address - Country:US
Mailing Address - Phone:815-714-2932
Mailing Address - Fax:
Practice Address - Street 1:121 SPRINGFIELD AVE STE 4
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6545
Practice Address - Country:US
Practice Address - Phone:815-714-2932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-11
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
No224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthistGroup - Multi-Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty