Provider Demographics
NPI:1871892398
Name:VALLEY ORTHOTIC SPECIALISTS, INC
Entity type:Organization
Organization Name:VALLEY ORTHOTIC SPECIALISTS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED ORTHOTIST
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:540-667-3631
Mailing Address - Street 1:1726 AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2807
Mailing Address - Country:US
Mailing Address - Phone:540-667-3631
Mailing Address - Fax:540-667-3632
Practice Address - Street 1:212 LINDEN DR STE 156-158
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2862
Practice Address - Country:US
Practice Address - Phone:540-667-3631
Practice Address - Fax:540-667-3632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-23
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2397335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810015957Medicaid
6296160001OtherMEDICARE PTAN
VA1427284538Medicaid