Provider Demographics
NPI:1851763130
Name:RESTORATIVE PROSTHETICS, LLC.
Entity Type:Organization
Organization Name:RESTORATIVE PROSTHETICS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:MCKENZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAMPLER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:865-405-9133
Mailing Address - Street 1:11002 KINGSTON PIKE STE 204
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-2829
Mailing Address - Country:US
Mailing Address - Phone:865-288-7188
Mailing Address - Fax:865-288-7178
Practice Address - Street 1:11002 KINGSTON PIKE STE 204
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-2829
Practice Address - Country:US
Practice Address - Phone:865-288-7188
Practice Address - Fax:865-288-7178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment