Provider Demographics
NPI:1659374213
Name:WALKABOUT ORTHOTICS & PROSTHETICS
Entity Type:Organization
Organization Name:WALKABOUT ORTHOTICS & PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:BOCPO
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 1:1815 STEWART AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-5373
Practice Address - Country:US
Practice Address - Phone:715-849-8703
Practice Address - Fax:715-849-9353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41786800Medicaid
WI41786800Medicaid