Provider Demographics
NPI:1316059876
Name:LAWALL PROSTHETICS ORTHOTICS INC
Entity type:Organization
Organization Name:LAWALL PROSTHETICS ORTHOTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:T
Authorized Official - Last Name:LAWALL
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:800-735-4627
Mailing Address - Street 1:3000 CABOT BLVD W
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1800
Mailing Address - Country:US
Mailing Address - Phone:215-338-6611
Mailing Address - Fax:215-338-9579
Practice Address - Street 1:1600 ROCKLAND RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3607
Practice Address - Country:US
Practice Address - Phone:302-429-7625
Practice Address - Fax:302-429-7683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1998204043335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000256916Medicaid