Provider Demographics
NPI:1285821637
Name:ORTHO REHAB DESIGNS PROSTHETICS AND ORTHOTICS, INC.
Entity type:Organization
Organization Name:ORTHO REHAB DESIGNS PROSTHETICS AND ORTHOTICS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:S
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:702-388-9909
Mailing Address - Street 1:2578 BELCASTRO ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-3067
Mailing Address - Country:US
Mailing Address - Phone:702-388-9909
Mailing Address - Fax:702-388-9929
Practice Address - Street 1:2578 BELCASTRO ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-3067
Practice Address - Country:US
Practice Address - Phone:702-388-9909
Practice Address - Fax:702-388-9929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMP00102335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003302062Medicaid
NV003302062Medicaid