Organization
LIFE IN MOTION ORTHOTIC & PROSTHETIC CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL A ROLLE ABC CERTIFIED CP2919 (PRESIDENT, O & P PRACTICIONER)
(316) 640-7267
Entity
Organization
Contact information
Practice address
443 N SAINT FRANCIS AVE STE E, WICHITA, KS 67202-2629
(316) 640-7267
(620) 225-0102
Mailing address
PO BOX 55, WICHITA, KS 67201-0055
(316) 640-7267
(620) 225-0102
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
036F01
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
118318
BCBS KS
KS
05
—
200405850A
—
KS
Enumeration date
06/26/2006
Last updated
07/21/2022
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