Provider Demographics
NPI:1861948242
Name:NEXTREMITY PROSTHETIC DESIGN, LLC
Entity type:Organization
Organization Name:NEXTREMITY PROSTHETIC DESIGN, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERMOSILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-830-6161
Mailing Address - Street 1:471 E 1000 S STE F
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-3694
Mailing Address - Country:US
Mailing Address - Phone:855-407-1227
Mailing Address - Fax:855-228-4222
Practice Address - Street 1:4115 E VALLEY AUTO DR STE 202
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4612
Practice Address - Country:US
Practice Address - Phone:800-311-5899
Practice Address - Fax:866-710-3106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-26
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty