Provider Demographics
NPI:1780629048
Name:DE LA TORRE ORTHOTICS & PROSTHETICS
Entity Type:Organization
Organization Name:DE LA TORRE ORTHOTICS & PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIMKUEHLER MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-325-2650
Mailing Address - Street 1:300 ALPHA DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-2908
Mailing Address - Country:US
Mailing Address - Phone:412-599-1138
Mailing Address - Fax:412-599-1130
Practice Address - Street 1:2644 MOSSIDE BLVD
Practice Address - Street 2:SUITE 118
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3348
Practice Address - Country:US
Practice Address - Phone:412-457-0500
Practice Address - Fax:412-457-0555
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNION ORTHOTICS & PROSTHETICS CO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-19
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA332B00000X, 332BC3200X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
219480OtherHEALTH AMERICA/ ASSURANCE
PA282755OtherBLUE CROSS BLUE SHIELD
PA0252949OtherCIGNA INSURANCE
1001202OtherGATEWAY INSURANCE
72110OtherUNISON ADVANTAGE
000070OtherUPMC INSURANCE
219480OtherADVANTRA
PA0005621720002Medicaid
1001202OtherGATEWAY INSURANCE