Provider Demographics
NPI:1265766018
Name:TEXAS ORTHOTICS INC
Entity type:Organization
Organization Name:TEXAS ORTHOTICS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOWRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-795-5440
Mailing Address - Street 1:2382 FARADAY AVENUE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-7220
Mailing Address - Country:US
Mailing Address - Phone:760-795-5440
Mailing Address - Fax:214-501-0299
Practice Address - Street 1:2380 DEAN WAY
Practice Address - Street 2:SUITE 140
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-1379
Practice Address - Country:US
Practice Address - Phone:817-416-7400
Practice Address - Fax:800-454-9615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-28
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX101306335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151548801Medicaid
TX151547001Medicaid
TX151548801Medicaid