Organization
IMPACT PROSTHETIC SOLUTIONS, LLC
Active
Other names
Impact Orthopedics, Impact Prosthetics & Orthotics
Organization subpart
No
Provider details
NPI number
Authorized official
RICO DARRYL PHRONEBARGER (CO-OWNER/MANAGER)
(704) 510-2204
Entity
Organization
Contact information
Practice address
3210 PROSPERITY CHURCH RD STE 101, CHARLOTTE, NC 28269-8194
(704) 510-2204
(704) 510-2218
Mailing address
3210 PROSPERITY CHURCH RD STE 101, CHARLOTTE, NC 28269-8194
(704) 510-2204
(704) 510-2218
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7704797
—
NC
Enumeration date
02/06/2008
Last updated
06/11/2019
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