Provider Demographics
NPI:1891300604
Name:PIVOT PROSTHETICS AND ORTHOTICS, LLC
Entity Type:Organization
Organization Name:PIVOT PROSTHETICS AND ORTHOTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRODIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:307-670-0007
Mailing Address - Street 1:2007 S DOUGLAS HWY STE 130
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-5400
Mailing Address - Country:US
Mailing Address - Phone:307-696-8016
Mailing Address - Fax:307-206-8104
Practice Address - Street 1:2007 S DOUGLAS HWY STE 130
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-5400
Practice Address - Country:US
Practice Address - Phone:307-696-8016
Practice Address - Fax:307-206-8104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-09
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty