Provider Demographics
NPI:1235133943
Name:TOTAL REHAB ORTHOTICS & PROSTHETICS INC
Entity type:Organization
Organization Name:TOTAL REHAB ORTHOTICS & PROSTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:FOUST
Authorized Official - Last Name:MARCHANT
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:910-824-0058
Mailing Address - Street 1:PO BOX 87067
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-7067
Mailing Address - Country:US
Mailing Address - Phone:910-323-9016
Mailing Address - Fax:910-486-8712
Practice Address - Street 1:2407 N ELM ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-3658
Practice Address - Country:US
Practice Address - Phone:910-618-1935
Practice Address - Fax:910-618-9920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1005584332B00000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703482Medicaid
NC0478VOtherBCBS
8238886OtherUNITED HEALTHCARE
NC0478VOtherBCBS