Provider Demographics
NPI:1700972361
Name:BIO PROSTHETIC-ORTHOTIC LAB, INC.
Entity Type:Organization
Organization Name:BIO PROSTHETIC-ORTHOTIC LAB, INC.
Other - Org Name:BIO LAB
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:BANKS
Authorized Official - Last Name:SAIHATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-726-4092
Mailing Address - Street 1:21785 FILIGREE COURT
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147
Mailing Address - Country:US
Mailing Address - Phone:703-726-4092
Mailing Address - Fax:703-726-4095
Practice Address - Street 1:21785 FILIGREE COURT
Practice Address - Street 2:SUITE 210
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147
Practice Address - Country:US
Practice Address - Phone:703-726-4092
Practice Address - Fax:703-726-4095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAB600986332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0728670Medicaid
VA9190724Medicaid
VA9190724Medicaid