Provider Demographics
NPI:1710621669
Name:FREEDOM PROSTHETIC & ORTHOTICS, LLC
Entity Type:Organization
Organization Name:FREEDOM PROSTHETIC & ORTHOTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:FJELDSTED
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:435-688-9338
Mailing Address - Street 1:356 E 600 S
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3949
Mailing Address - Country:US
Mailing Address - Phone:435-688-9338
Mailing Address - Fax:435-673-3747
Practice Address - Street 1:2202 N MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-9772
Practice Address - Country:US
Practice Address - Phone:435-383-9000
Practice Address - Fax:435-673-3747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier