Provider Demographics
NPI:1891944468
Name:ALLTECH O & P SERVICES, LLC
Entity Type:Organization
Organization Name:ALLTECH O & P SERVICES, LLC
Other - Org Name:ALLTECH O & P SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:D
Authorized Official - Last Name:DELEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-484-9699
Mailing Address - Street 1:2781 SW WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-6307
Mailing Address - Country:US
Mailing Address - Phone:817-484-9699
Mailing Address - Fax:817-484-9877
Practice Address - Street 1:7989 W VIRGINIA DR
Practice Address - Street 2:SUITE 104
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3837
Practice Address - Country:US
Practice Address - Phone:972-709-6070
Practice Address - Fax:972-709-6177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX548335E00000X
TX579335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5656850003Medicare NSC