Provider Demographics
NPI:1578318648
Name:TECH RIDGE PROSTHETICS, PLLC
Entity Type:Organization
Organization Name:TECH RIDGE PROSTHETICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAELLO
Authorized Official - Suffix:
Authorized Official - Credentials:CP, LP
Authorized Official - Phone:512-297-2724
Mailing Address - Street 1:3503 WILD CHERRY DR STE 13
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-1822
Mailing Address - Country:US
Mailing Address - Phone:512-297-2724
Mailing Address - Fax:
Practice Address - Street 1:1908 YAUPON TRL UNIT 101
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-6529
Practice Address - Country:US
Practice Address - Phone:512-297-2724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TECH RIDGE PROSTHETICS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier