Provider Demographics
NPI:1780609594
Name:ABLE BRACE & LIMB,LLC
Entity type:Organization
Organization Name:ABLE BRACE & LIMB,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:DEANNE
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-235-2253
Mailing Address - Street 1:2301 W WALNUT ST
Mailing Address - Street 2:SUITE 17
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-3586
Mailing Address - Country:US
Mailing Address - Phone:417-235-2253
Mailing Address - Fax:417-235-3985
Practice Address - Street 1:2301 W WALNUT ST
Practice Address - Street 2:SUITE 17
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3586
Practice Address - Country:US
Practice Address - Phone:479-631-2253
Practice Address - Fax:479-631-3985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR4805380003Medicare NSC