Provider Demographics
NPI:1992813547
Name:WALL PROSTHETICS & ORTHOTICS, INC
Entity type:Organization
Organization Name:WALL PROSTHETICS & ORTHOTICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ PROSTHETIST/ ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, CPO, FAAOP
Authorized Official - Phone:978-745-3500
Mailing Address - Street 1:2 CENTENNIAL DR
Mailing Address - Street 2:UNIT 6A
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-7911
Mailing Address - Country:US
Mailing Address - Phone:978-538-9800
Mailing Address - Fax:978-538-9811
Practice Address - Street 1:2 CENTENNIAL DR
Practice Address - Street 2:UNIT 6A
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-7911
Practice Address - Country:US
Practice Address - Phone:978-538-9800
Practice Address - Fax:978-538-9811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA704517OtherHPHC ORTHOTICS/ PROSTHET
MA685834OtherTUFTS ORTHOTICS/ PROSTHET
MA986834OtherNETWORK HEALTH O & P
MA392254OtherBC/BS ORTHOTICS/ PROSTHET
MA0020903OtherNHP ORTHOTICS/ PROSTHETIC
MA1500007Medicaid
MA704517OtherHPHC ORTHOTICS/ PROSTHET