Provider Demographics
NPI:1487291688
Name:NEVADA ORTHOTICS & PROSTHETICS, INC
Entity type:Organization
Organization Name:NEVADA ORTHOTICS & PROSTHETICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PETRA
Authorized Official - Middle Name:
Authorized Official - Last Name:THIESSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-233-5500
Mailing Address - Street 1:3435 W CHEYENNE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-8207
Mailing Address - Country:US
Mailing Address - Phone:702-233-5500
Mailing Address - Fax:702-233-5500
Practice Address - Street 1:1863 AIRFIED AVENUE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4004
Practice Address - Country:US
Practice Address - Phone:928-718-3987
Practice Address - Fax:702-233-2131
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEVADA ORTHOTICS & PROSTHETICS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier