Provider Demographics
NPI:1427731314
Name:KICKSTART ORTHOTICS AND PROSTHETICS, PLLC
Entity type:Organization
Organization Name:KICKSTART ORTHOTICS AND PROSTHETICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRINGS
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:509-359-5329
Mailing Address - Street 1:1120 N PINES RD STE C
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4942
Mailing Address - Country:US
Mailing Address - Phone:509-795-1007
Mailing Address - Fax:509-795-1008
Practice Address - Street 1:1120 N PINES RD STE C
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4942
Practice Address - Country:US
Practice Address - Phone:509-795-1007
Practice Address - Fax:509-795-1008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier