Provider Demographics
NPI:1790052926
Name:FORRESTER CUSTOM PROSTHETICS
Entity Type:Organization
Organization Name:FORRESTER CUSTOM PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:FORRESTER
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:1775-657-9500
Mailing Address - Street 1:615 MARGRAVE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3542
Mailing Address - Country:US
Mailing Address - Phone:775-657-9500
Mailing Address - Fax:775-657-9520
Practice Address - Street 1:615 MARGRAVE DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3542
Practice Address - Country:US
Practice Address - Phone:775-657-9500
Practice Address - Fax:775-657-9520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier