Provider Demographics
NPI:1285434605
Name:DIVINE PROSTHETICS & ORTHOTICS (DPO) LLC
Entity type:Organization
Organization Name:DIVINE PROSTHETICS & ORTHOTICS (DPO) LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO,CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GIGI
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:BOCPO,LPO
Authorized Official - Phone:346-412-6701
Mailing Address - Street 1:20320 NORTHWEST FWY STE 300
Mailing Address - Street 2:
Mailing Address - City:JERSEY VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:77065-5643
Mailing Address - Country:US
Mailing Address - Phone:346-412-6701
Mailing Address - Fax:346-601-4546
Practice Address - Street 1:20320 NORTHWEST FWY STE 300
Practice Address - Street 2:
Practice Address - City:JERSEY VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:77065-5643
Practice Address - Country:US
Practice Address - Phone:346-601-4545
Practice Address - Fax:346-601-4546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-14
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier