Provider Demographics
NPI:1023296035
Name:DJO, LLC
Entity type:Organization
Organization Name:DJO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP/CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:TYRRELL-KNOTT
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:866-356-7846
Mailing Address - Street 1:5919 SEA OTTER PL STE 200
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-6750
Mailing Address - Country:US
Mailing Address - Phone:800-321-9549
Mailing Address - Fax:800-936-6569
Practice Address - Street 1:6544 N US HIGHWAY 41 STE 101B
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-1714
Practice Address - Country:US
Practice Address - Phone:800-321-9549
Practice Address - Fax:800-936-8569
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DJO, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-01
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1283420001Medicare NSC