Provider Demographics
NPI:1417142001
Name:ARISE ORTHOTICS & PROSTHETICS, INC.
Entity Type:Organization
Organization Name:ARISE ORTHOTICS & PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUFFEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-755-9500
Mailing Address - Street 1:8338 HIGHWAY 65 NE STE E
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55432-1365
Mailing Address - Country:US
Mailing Address - Phone:763-755-9500
Mailing Address - Fax:763-755-9510
Practice Address - Street 1:8338 HIGHWAY 65 NE STE E
Practice Address - Street 2:
Practice Address - City:SPRING LAKE PARK
Practice Address - State:MN
Practice Address - Zip Code:55432-1365
Practice Address - Country:US
Practice Address - Phone:763-755-9500
Practice Address - Fax:763-755-9510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN376627000Medicaid
MN6013110001Medicare NSC