Provider Demographics
NPI:1699779280
Name:TOTAL REHAB ORTHOTICS & PROSTHETICS INC
Entity type:Organization
Organization Name:TOTAL REHAB ORTHOTICS & PROSTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:FOSUT
Authorized Official - Last Name:MARCHANT
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
Authorized Official - Phone:910-323-9016
Mailing Address - Street 1:PO BOX 87067
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-7067
Mailing Address - Country:US
Mailing Address - Phone:910-323-9016
Mailing Address - Fax:910-486-8712
Practice Address - Street 1:234 OWEN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3414
Practice Address - Country:US
Practice Address - Phone:910-323-9016
Practice Address - Fax:910-486-8712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1005584332B00000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
8238886OtherUNITED HEALTHCARE
NC0478VOtherBCBS
NC7701177Medicaid
NC0535700001Medicare NSC