Provider Demographics
NPI:1477792653
Name:REACH ORTHOTIC & PROSTHETIC SERVICES
Entity Type:Organization
Organization Name:REACH ORTHOTIC & PROSTHETIC SERVICES
Other - Org Name:SILHOUETTE MASTECTOMY BOUTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BEACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-595-9800
Mailing Address - Street 1:12715 WARWICK BLVD STE V
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-1800
Mailing Address - Country:US
Mailing Address - Phone:757-930-0139
Mailing Address - Fax:
Practice Address - Street 1:12715 WARWICK BLVD STE V
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-1800
Practice Address - Country:US
Practice Address - Phone:757-930-0139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REACH ORTHOTIC & PROSTHETIC SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA002706335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4645700001Medicare NSC