Provider Demographics
NPI:1487738860
Name:GAITWAY ORTHOTICS, INC.
Entity type:Organization
Organization Name:GAITWAY ORTHOTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DOBBS
Authorized Official - Suffix:JR
Authorized Official - Credentials:CPED
Authorized Official - Phone:256-216-8376
Mailing Address - Street 1:PO BOX 567
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35612-0567
Mailing Address - Country:US
Mailing Address - Phone:256-216-8376
Mailing Address - Fax:256-216-8377
Practice Address - Street 1:109 N MARION ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2537
Practice Address - Country:US
Practice Address - Phone:256-216-8376
Practice Address - Fax:256-216-8377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL645332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5408110001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER