Provider Demographics
NPI:1366806028
Name:PROPEL ORTHO LLC
Entity type:Organization
Organization Name:PROPEL ORTHO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOR
Authorized Official - Middle Name:L
Authorized Official - Last Name:MATAYA
Authorized Official - Suffix:
Authorized Official - Credentials:CPOA
Authorized Official - Phone:267-980-7415
Mailing Address - Street 1:3033 WINKLER AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-9413
Mailing Address - Country:US
Mailing Address - Phone:267-980-7415
Mailing Address - Fax:215-638-2119
Practice Address - Street 1:3033 WINKLER AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-9413
Practice Address - Country:US
Practice Address - Phone:267-980-7415
Practice Address - Fax:215-638-2119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier