Organization
PEDIATRIC PROSTHETICS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LINDA PUTBACK-BEAN (PRESIDENT)
(281) 897-1108
Entity
Organization
Contact information
Practice address
12926 WILLOW CHASE DR, HOUSTON, TX 77070-5641
(281) 897-1108
(281) 897-8462
Mailing address
12926 WILLOW CHASE DR, HOUSTON, TX 77070-5641
(281) 897-1108
(281) 897-8462
Taxonomy
Speciality
Code
Description
License number
State
225000000X
Orthotic Fitter
Primary
101134
TX
335E00000X
Prosthetic/Orthotic Supplier
101134
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1670572-01
—
TX
01
—
531649
BLUE CROSS BLUE SHIEL
TX
Enumeration date
06/10/2005
Last updated
02/18/2010
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