Provider Demographics
NPI:1750656039
Name:SOUND LIMBS ORTHOTICS, INC
Entity Type:Organization
Organization Name:SOUND LIMBS ORTHOTICS, INC
Other - Org Name:SOUND LIMBS ORTHOTICS & PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:AM
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-784-4345
Mailing Address - Street 1:39 S LISBON RD
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-1404
Mailing Address - Country:US
Mailing Address - Phone:207-784-4345
Mailing Address - Fax:207-783-9496
Practice Address - Street 1:45 MALLETT DR SUITE 102
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-1312
Practice Address - Country:US
Practice Address - Phone:207-865-6060
Practice Address - Fax:207-865-6061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME126940000Medicaid
0523160001Medicare UPIN