Organization
GAITWELL ORTHOTICS AND PEDORTHICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH A WALLACE (OFFICE MANANGER)
(937) 456-4800
Entity
Organization
Contact information
Practice address
560 S LOOP RD, EDGEWOOD, KY 41017-3405
(859) 301-0622
(513) 889-1850
Mailing address
1 N COMMERCE PARK DR STE 306, CINCINNATI, OH 45215-3188
(513) 829-2217
(513) 889-1850
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0
STRATOSE
KY
01
—
000000298877
ANTHEM BLUE CROSS
KY
01
—
106156400
ACS WORKERS COMP
KY
05
—
90006024
—
KY
01
—
A146596
MULTI PLAN
KY
Enumeration date
01/25/2006
Last updated
06/18/2020
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