Provider Demographics
NPI:1700123833
Name:DE LA TORRE ORTHOTICS & PROSTHETICS
Entity Type:Organization
Organization Name:DE LA TORRE ORTHOTICS & PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIMKUEHLER MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-325-2650
Mailing Address - Street 1:300 ALPHA DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-2908
Mailing Address - Country:US
Mailing Address - Phone:412-599-1138
Mailing Address - Fax:412-599-1155
Practice Address - Street 1:400 NORTHPOINTE CIRCLE
Practice Address - Street 2:SUITE 102
Practice Address - City:SEVEN FIELDS
Practice Address - State:PA
Practice Address - Zip Code:16046-7867
Practice Address - Country:US
Practice Address - Phone:724-779-7700
Practice Address - Fax:724-779-7705
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNION ORTHOTICS & PROSTHETICS CO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-09
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005621720002Medicaid
PA1001202OtherGATEWAY
PA000070OtherUPMC
PA219480OtherCOVENTRY
PA282755OtherBLUE CROSS BLUE SHIELD
PA219480OtherADVANTRA
PA282755OtherBLUE CROSS BLUE SHIELD