Provider Demographics
NPI:1689268369
Name:BOLT ONS
Entity Type:Organization
Organization Name:BOLT ONS
Other - Org Name:NEXT STEP PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KAYSER
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:928-255-8665
Mailing Address - Street 1:123 BIRCH AVE SUITE 100
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001
Mailing Address - Country:US
Mailing Address - Phone:928-772-5777
Mailing Address - Fax:928-271-8459
Practice Address - Street 1:123 W. BIRCH AVE
Practice Address - Street 2:STE 100
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001
Practice Address - Country:US
Practice Address - Phone:928-772-5777
Practice Address - Fax:928-271-8459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-23
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ089633Medicaid