Organization
SRT PROSTHETICS & ORTHOTICS LLC
Active
Other names
ForMotion Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
BRADFORD NEIL GARDNER (DIRECTOR)
(615) 864-8783
Entity
Organization
Contact information
Practice address
3818 W JEFFERSON BLVD, FORT WAYNE, IN 46804-6840
(260) 432-8886
(260) 432-1137
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
—
000000229696
ANTHEM
IN
05
—
200360760
—
IN
01
—
21825
ABP
IN
Enumeration date
06/03/2006
Last updated
02/23/2026
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