Provider Demographics
NPI:1487104014
Name:TECH RIDGE PROSTHETICS, PLLC
Entity type:Organization
Organization Name:TECH RIDGE PROSTHETICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAELLO
Authorized Official - Suffix:
Authorized Official - Credentials:CP, LP
Authorized Official - Phone:512-993-7054
Mailing Address - Street 1:3503 WILD CHERRY DR STE 13
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-1822
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3503 WILD CHERRY DR STE 13
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-1822
Practice Address - Country:US
Practice Address - Phone:512-297-2724
Practice Address - Fax:512-467-4695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-06
Last Update Date:2023-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1806335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier