Provider Demographics
NPI:1881044519
Name:REICHERT PROSTHETICS & ORTHOTICS, LLC
Entity Type:Organization
Organization Name:REICHERT PROSTHETICS & ORTHOTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUPONT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-654-4300
Mailing Address - Street 1:5027 GREEN BAY RD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-1771
Mailing Address - Country:US
Mailing Address - Phone:262-654-4600
Mailing Address - Fax:262-654-4305
Practice Address - Street 1:15 TOWER CT
Practice Address - Street 2:SUITE 245
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3336
Practice Address - Country:US
Practice Address - Phone:262-654-4300
Practice Address - Fax:262-654-4305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-14
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier