Provider Demographics
NPI:1205931102
Name:ORTHOTIC & PROSTHETIC TECHNOLOGIES INC
Entity type:Organization
Organization Name:ORTHOTIC & PROSTHETIC TECHNOLOGIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REG COMPLIANCE SPECIALIST III
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGELINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-961-2102
Mailing Address - Street 1:PO BOX 650846
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0846
Mailing Address - Country:US
Mailing Address - Phone:512-377-2323
Mailing Address - Fax:512-374-9993
Practice Address - Street 1:8000 ANDERSON SQ
Practice Address - Street 2:STE 301A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-8421
Practice Address - Country:US
Practice Address - Phone:512-377-2323
Practice Address - Fax:512-374-9993
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HANGER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-14
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX656680000261QP2000X
332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1049666OtherCIGNA
TX7716547OtherAETNA
TX10018764OtherAMERIGROUP
TX531761OtherBCBS PROVIDER AUSTIN
TX1025407OtherACM-UNITED HEALTHCARE
TX0042KXOtherBCBS PT AUSTIN
TX5609664OtherFIRST HEALTH
TX170962801Medicaid
TX170962802Medicaid
TX170962801Medicaid