Provider Demographics
NPI:1932446812
Name:PROSTHETIX SHOP LLC
Entity Type:Organization
Organization Name:PROSTHETIX SHOP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLES
Authorized Official - Suffix:
Authorized Official - Credentials:LP
Authorized Official - Phone:513-843-5126
Mailing Address - Street 1:431 OHIO PIKE
Mailing Address - Street 2:SUITE 124 SOUTH
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-3375
Mailing Address - Country:US
Mailing Address - Phone:513-843-5126
Mailing Address - Fax:513-843-5164
Practice Address - Street 1:431 OHIO PIKE
Practice Address - Street 2:SUITE 124 SOUTH
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-3375
Practice Address - Country:US
Practice Address - Phone:513-843-5126
Practice Address - Fax:513-843-5164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-11
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH304335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier