Provider Demographics
NPI:1679043525
Name:ADAPTIVE PROSTHETICS & ORTHOTICS LLC
Entity Type:Organization
Organization Name:ADAPTIVE PROSTHETICS & ORTHOTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HEWETT
Authorized Official - Suffix:
Authorized Official - Credentials:CP, BOCPO
Authorized Official - Phone:860-633-7298
Mailing Address - Street 1:90 NATIONAL DR STE 1
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1247
Mailing Address - Country:US
Mailing Address - Phone:860-633-7298
Mailing Address - Fax:860-659-1282
Practice Address - Street 1:100 RETREAT AVE STE 302
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2528
Practice Address - Country:US
Practice Address - Phone:860-266-1845
Practice Address - Fax:860-757-5803
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADAPTIVE PROSTHETICS & ORTHOTICS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-04
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004178770Medicaid