Provider Demographics
NPI:1427427913
Name:LIFE IN MOTION ORTHOTIC & PROSTHETIC CENTER, INC.
Entity type:Organization
Organization Name:LIFE IN MOTION ORTHOTIC & PROSTHETIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROLLE
Authorized Official - Suffix:
Authorized Official - Credentials:ABC /BOC/BS
Authorized Official - Phone:316-640-7267
Mailing Address - Street 1:2601 CENTRAL AVE STE 22
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2606
Mailing Address - Country:US
Mailing Address - Phone:620-225-0113
Mailing Address - Fax:620-225-0102
Practice Address - Street 1:2601 CENTRAL AVE STE 22
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2606
Practice Address - Country:US
Practice Address - Phone:620-225-0113
Practice Address - Fax:620-225-0102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier