Organization
PERSONALIZED PROSTHETICS
Active
Organization
PERSONALIZED PROSTHETICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COLETTE SHRADER MS, CCA (OWNER)
(210) 802-8313
Entity
Organization
Contact information
Practice address
628 S PRESA ST # 5, SAN ANTONIO, TX 78210-1054
(210) 802-8313
Mailing address
628 S PRESA ST # 5, SAN ANTONIO, TX 78210-1054
(210) 802-8313
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
377522301
—
TX
Enumeration date
01/06/2017
Last updated
07/21/2020
Update your record
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