SRT PROSTHETICS & ORTHOTICS LLC (NPI# 1508804295) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508804295 |
| Entity Type | Organization |
| Organization Name | SRT PROSTHETICS & ORTHOTICS LLC |
| Practice Address |
4109 W Jefferson Blvd Ft Wayne IN 46804-6894 |
| Mailing Address |
408 E Washington St Butler IN 46721-1179 |
| Practice Telephone | 2604328886 |
| Practice Fax Number | 2604321137 |
| Mailing Telephone | 4196333961 |
| Mailing Fax Number | 4196333981 |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2019-02-18 |
| Authorized Official Name | LESLIE SIEBENALER (DIRECTOR OF OPERATIONS) |
| Authorized Official Telephone | 8666333961 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 335E00000X | Prosthetic/Orthotic Supplier | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | ANTHEM | 000000229696 | 01 |
| IN | 200360760 | 05 | |
| IN | ABP | 21825 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841698834 | Srt Prosthetics & Orthotics LLC | Prosthetic/Orthotic Supplier | 5220 S 27th St., Milwaukee, WI 53221 | 2014-12-08 |
| 1255681870 | Srt Prosthetics & Orthotics LLC | Prosthetic/Orthotic Supplier | 618 N High School Rd Ste B, Indianapolis, IN 46214-3684 | 2012-09-11 |
| 1295000909 | Srt Prosthetics & Orthotics LLC | Prosthetic/Orthotic Supplier | 1900 N Meridian St, Indianapolis, IN 46202-1304 | 2012-03-13 |
| 1497929434 | Srt Prosthetics & Orthotics LLC | Prosthetic/Orthotic Supplier | 406 N. Front St., Suite F, Mchenry, IL 60050 | 2008-04-22 |
| 1851409932 | Srt Prosthetics & Orthotics LLC | Prosthetic/Orthotic Supplier | 6475 Washington St., Suite 100, Gurnee, IL 60031 | 2006-08-28 |
| 1699712695 | Srt Prosthetics & Orthotics LLC | Prosthetic/Orthotic Supplier | 217 E Southway Blvd Ste 100, Kokomo, IN 46902-3577 | 2006-05-31 |
| 1245222785 | Srt Prosthetics & Orthotics LLC | Prosthetic/Orthotic Supplier | 408 E Washington St, Butler, IN 46721-1179 | 2005-08-19 |
| 1902156532 | Srt Prosthetics & Orthotics LLC | Prosthetic/Orthotic Supplier | 8936 Southpointe Dr, Suite B-1, Indianapolis, IN 46227-7507 | 2012-09-11 |
| 1134417009 | Srt Prosthetics & Orthotics LLC | Prosthetic/Orthotic Supplier | 3301 W Bethel Ave, Muncie, IN 47304-5402 | 2011-07-13 |
| Street Address |
4109 W JEFFERSON BLVD |
| City | FT WAYNE |
| State | IN |
| Zip Code | 46804-6894 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396350344 | Derek Mumaw | Physical Therapist | 8420 Illinois Rd, Fort Wayne, IN 46804 | 2020-09-15 |
| 1942840228 | Erin M Mason | Behavior Technician | 5601 Coventry Ln, Fort Wayne, IN 46804 | 2020-01-14 |
| 1346880879 | Emily A Abdalla | Behavior Technician | 5601 Coventry Ln., Fort Wayne, IN 46804 | 2020-01-13 |
| 1083265433 | Fort Wayne Endodontics | Dentist | 9407 Illinois Rd, Fort Wayne, IN 46804 | 2019-09-26 |
| 1689140949 | Harrison Dental Group II, LLC | Dentist | 1333 Getz Rd, Fort Wayne, IN 46804 | 2018-10-15 |
| 1346731908 | Erin Nicole Zimmerman | Nurse Practitioner | 10170 Illinois Rd # 14, Fort Wayne, IN 46804 | 2018-05-19 |
| 1417446022 | Mary Harrington | Physical Therapist | 3320 Copper Hill Run, Fort Wayne, IN 46804 | 2018-05-09 |
| 1942701214 | Joshawa Todd Torres | Marriage & Family Therapist | 5651 Coventry Ln # 116, Fort Wayne, IN 46804 | 2018-02-22 |
| 1194235408 | Mitchell Kory Meyer | Specialist/Technologist | 9125 Yellow Tree Ct, Fort Wayne, IN 46804 | 2017-10-02 |
| 1902324916 | Emily Rene Sagstetter | Specialist/Technologist | 6034 Liberty Glade Ct, Fort Wayne, IN 46804 | 2017-08-30 |
| Find all providers in zip 46804 | ||||
| Taxonomy Code | 335E00000X |
| Grouping | Suppliers |
| Classification | Prosthetic/Orthotic Supplier |
| An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639781081 | Kenney Orthopedics Indianapolis, LLC | Prosthetic/Orthotic Supplier | 1801 N Senate Blvd Ste 420, Indianapolis, IN 46202-1228 | 2020-08-18 |
| 1982220109 | Bionic Prosthetics and Orthotics Group LLC | Prosthetic/Orthotic Supplier | 3647 Clifty Dr, Madison, IN 47250-1649 | 2020-06-23 |
| 1154941557 | Radiance Renewed | Prosthetic/Orthotic Supplier | 9445 Indianapolis Blvd Ste 1042, Highland, IN 46322-2648 | 2020-04-26 |
| 1295397735 | Orthopedic and Sports Medicine Center of Northern Indiana, Inc | Prosthetic/Orthotic Supplier | 200 E Jackson Blvd Ste 130, Elkhart, IN 46516-3513 | 2019-07-05 |
| 1710465166 | Cranial Technologies Inc | Prosthetic/Orthotic Supplier | 10603 N Meridian St Ste 120, Indianapolis, IN 46290-1055 | 2018-07-29 |
| 1285135913 | Excel Orthotics and Prosthetics LLC | Prosthetic/Orthotic Supplier | 3200 Sycamore Ct Ste 2b, Columbus, IN 47203-1552 | 2018-02-27 |
| 1003326174 | Bionic Prosthetics and Orthotics Group LLC | Prosthetic/Orthotic Supplier | 3130a Windsor Ct, Elkhart, IN 46514-5556 | 2017-10-03 |
| 1285144352 | Bionic Prosthetics and Orthotics Group LLC | Prosthetic/Orthotic Supplier | 1101 Glendale Blvd Ste 105, Valparaiso, IN 46383-3769 | 2017-10-03 |
| 1669904579 | Jordan Poynter | Prosthetic/Orthotic Supplier | 3708 S Lafountain St, Kokomo, IN 46902-3805 | 2017-03-30 |
| 1184156101 | Shawn Dee Brown | Prosthetic/Orthotic Supplier | 2410 N Glendale Dr Ste C, Fort Wayne, IN 46804-8909 | 2017-03-29 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.