Provider Demographics
NPI:1770792145
Name:CENTER FOR PROSTHETICS ORTHOTICS, INC.
Entity type:Organization
Organization Name:CENTER FOR PROSTHETICS ORTHOTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:VARNAU
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, LPO
Authorized Official - Phone:206-328-4276
Mailing Address - Street 1:12911 120TH AVE NE
Mailing Address - Street 2:SUITE E 10
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3027
Mailing Address - Country:US
Mailing Address - Phone:206-328-4276
Mailing Address - Fax:206-328-1037
Practice Address - Street 1:12911 120TH AVE NE
Practice Address - Street 2:SUITE E 10
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3027
Practice Address - Country:US
Practice Address - Phone:206-328-4276
Practice Address - Fax:206-328-1037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPS000000021744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9015561Medicaid