Organization
XTREME PROSTHETICS, LLC.
Active
Organization
XTREME PROSTHETICS, LLC.
Active
Other names
Xtreme Prosthetics & Orthotics, LLC, ForMotion Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
BRADFORD NEIL GARDNER (DIRECTOR)
(615) 864-8783
Entity
Organization
Contact information
Practice address
1005 WEST COLUMBIA ST, SUITE B, SOMERSET, KY 42503
(606) 451-0668
(606) 451-0078
Mailing address
102 WOODMONT BLVD STE 400, NASHVILLE, TN 37205-5217
(615) 550-8774
(615) 454-5352
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1245534585
NPI
KY
01
—
6469320001
PTAN
KY
Enumeration date
12/30/2010
Last updated
05/29/2026
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