Organization
CENTER FOR ORTHOTIC & PROSTHETIC EXCELLENCE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. AMIT BHANTI CPO (CEO)
(309) 676-2276
Entity
Organization
Contact information
Practice address
9615 KEILMAN ST, SUITE 200, SAINT JOHN, IN 46373
(219) 365-0248
(219) 365-0072
Mailing address
741 W MAIN STREET, PEORIA, IL 61606
(309) 676-2276
(888) 663-6322
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
213.000102
STATE OF ILLINOIS - LICENSED ORTHOTIST
IL
01
—
CO003904
AMERICAN BOARD FOR CERTIFICATION IN ORTHOTICS & PROSTHETICS
IN
Enumeration date
12/20/2007
Last updated
09/24/2024
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