Provider Demographics
NPI:1609637800
Name:WALKABOUT ORTHOTICS & PROSTHETICS
Entity Type:Organization
Organization Name:WALKABOUT ORTHOTICS & PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:THURS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-849-8703
Mailing Address - Street 1:1815 STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-5373
Mailing Address - Country:US
Mailing Address - Phone:715-849-8703
Mailing Address - Fax:715-849-9353
Practice Address - Street 1:200 E UPHAM ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-1543
Practice Address - Country:US
Practice Address - Phone:715-387-1818
Practice Address - Fax:715-387-2473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier