Organization
SRT PROSTHETICS & ORTHOTICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE SIEBENALER (DIRECTOR OF OPERATIONS)
(866) 633-3961
Entity
Organization
Contact information
Practice address
406 N. FRONT ST., SUITE F, MCHENRY, IL 60050
(815) 679-6900
(419) 633-3961
Mailing address
408 E WASHINGTON ST, BUTLER, IN 46721-1179
(419) 633-3961
(419) 633-3981
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04932217
BCBS
IL
Enumeration date
04/22/2008
Last updated
02/18/2019
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