Provider Demographics
NPI:1205429305
Name:VALLEY ORTHOTIC SPECIALISTS, INC
Entity type:Organization
Organization Name:VALLEY ORTHOTIC SPECIALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:540-667-3631
Mailing Address - Street 1:1726 AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2807
Mailing Address - Country:US
Mailing Address - Phone:540-667-3631
Mailing Address - Fax:540-667-3632
Practice Address - Street 1:1951 EVELYN BYRD AVE STE E
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3483
Practice Address - Country:US
Practice Address - Phone:540-242-4499
Practice Address - Fax:540-779-0393
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY ORTHOTIC SPECIALISTS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1871892398Medicaid
VA381001958Medicaid