Provider Demographics
NPI:1891751723
Name:DENHAM ORTHOTICS AND FITNESS
Entity Type:Organization
Organization Name:DENHAM ORTHOTICS AND FITNESS
Other - Org Name:EVOLVE PROSTHETICS AND ORTHOTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KOVACH
Authorized Official - Suffix:
Authorized Official - Credentials:CP,BOCO
Authorized Official - Phone:702-898-6000
Mailing Address - Street 1:601 WHITNEY RANCH DR
Mailing Address - Street 2:#C-17
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2642
Mailing Address - Country:US
Mailing Address - Phone:702-898-6000
Mailing Address - Fax:702-898-6080
Practice Address - Street 1:601 WHITNEY RANCH DR
Practice Address - Street 2:#C-17
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2642
Practice Address - Country:US
Practice Address - Phone:702-898-6000
Practice Address - Fax:702-898-6080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2021-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECO003963222Z00000X
DECP003298224P00000X
NVC15202335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003302256Medicaid
NV4385780001OtherPTAN