Provider Demographics
NPI:1205370202
Name:STRIVE ORTHOTICS & PROSTHETICS, LLC
Entity type:Organization
Organization Name:STRIVE ORTHOTICS & PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ISMET
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:757-705-7061
Mailing Address - Street 1:41400 DEQUINDRE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-3763
Mailing Address - Country:US
Mailing Address - Phone:586-803-4325
Mailing Address - Fax:586-803-4326
Practice Address - Street 1:41400 DEQUINDRE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-3763
Practice Address - Country:US
Practice Address - Phone:586-803-4325
Practice Address - Fax:586-803-4326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-09
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier