Provider Demographics
NPI:1760225148
Name:ORTHOTIC PROSTHETIC SOLUTIONS LLC
Entity type:Organization
Organization Name:ORTHOTIC PROSTHETIC SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANDRE
Authorized Official - Middle Name:SHONDALE
Authorized Official - Last Name:MOSTELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-316-5444
Mailing Address - Street 1:7754 FLORIDA BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4706
Mailing Address - Country:US
Mailing Address - Phone:225-316-5444
Mailing Address - Fax:
Practice Address - Street 1:2600 BELLE CHASSE HWY STE C
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-7156
Practice Address - Country:US
Practice Address - Phone:504-269-3915
Practice Address - Fax:504-324-0820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-14
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty