LISA E ROSTVOLD (NPI# 1558539338) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1558539338 |
Entity Type | Organization |
Organization Name | LISA E ROSTVOLD |
Other Organization Name | BLUE MOON SHOES |
Practice Address |
110 N Buffalo St Warsaw IN 46580-2754 |
Practice Telephone | 5742675537 |
Practice Fax Number | 5742676165 |
Mailing Telephone | 5742675537 |
Mailing Fax Number | 5742676165 |
Enumeration Date | 2008-02-14 |
Last Update Date | 2008-06-19 |
Authorized Official Name | MS. LISA ELLEN ROSTVOLD (OWNER) |
Authorized Official Telephone | 5742675537 |
Authorized Official Credential | CERTIFIED PEDORT |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 335E00000X | Prosthetic/Orthotic Supplier | CPED2624 | IN | Suppliers |
Other Name | Type Code |
---|---|
Blue Moon Shoes | Doing Business As Name - Organization |
Street Address |
110 N BUFFALO ST |
City | WARSAW |
State | IN |
Zip Code | 46580-2754 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1346803772 | Amber Rae Parker | Physical Therapy Assistant | 2695 Shelden St., Warsaw, IN 46580 | 2019-04-22 |
1194255794 | Tyler Scott Kronk | Counselor | 105 Enterprise Drive, Warsaw, IN 46580 | 2017-06-15 |
1306244231 | Indiana Physical Therapy, Inc. | Clinic/Center | 3300 Lake City Hwy., Warsaw, IN 46580 | 2014-12-09 |
1922434687 | Yen Thi Vu | Pharmacist | 2400 East Center St, Warsaw, IN 46580 | 2013-09-25 |
1982956934 | Marsha Lynn Dreyer | Occupational Therapy Assistant | 300 E. Prairie Street, Warsaw, IN 46580 | 2012-10-15 |
1215286109 | Planned Parenthood of Indiana Warsaw | Clinic/Center | 630 S. Buffalo St., Suite 1, Warsaw, IN 46580 | 2012-09-06 |
1952636243 | Magdi Gabriel | Orthopaedic Surgery | 2087 Phaesant Ridge Drive, Warsaw, IN 46580 | 2009-10-05 |
1316132996 | Assisted Living Concepts Inc | Assisted Living Facility | 425 Chinworth Court, Warsaw, IN 46580 | 2007-09-07 |
1598986101 | Ericka Ester Haynes | Occupational Therapist | 900 Provident Drive, Warsaw, IN 46580 | 2007-05-01 |
1881819555 | Hartwiger Enterprises, Inc. | Home Health | 3510 Commerce Dr., Warsaw, IN 46580 | 2007-04-16 |
Find all providers in zip 46580 |
Taxonomy Code | 335E00000X |
Grouping | Suppliers |
Classification | Prosthetic/Orthotic Supplier |
An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. |
Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1396916888 | Prevail Prosthetics and Orthotics, Inc | Prosthetic/Orthotic Supplier | 3159 E Center Street Ext, Warsaw, IN 46582-3901 | 2008-03-12 |
1265654842 | Transmed Associates, Inc. | Prosthetic/Orthotic Supplier | 2176 N Biomet Dr, Suite 2, Warsaw, IN 46582-6800 | 2007-05-03 |
1508106675 | Maxcare Orthotics and Prosthetics LLC | Prosthetic/Orthotic Supplier | 3159 E Center Street Ext, Warsaw, IN 46582-3901 | 2013-02-26 |
1033487111 | Maxcare Bionics Inc. | Prosthetic/Orthotic Supplier | 3159 E Center Street Ext, Warsaw, IN 46582-3901 | 2011-12-05 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1639781081 | Kenney Orthopedics Indianapolis, LLC | Prosthetic/Orthotic Supplier | 1801 N Senate Blvd Ste 420, Indianapolis, IN 46202-1228 | 2020-08-18 |
1982220109 | Bionic Prosthetics and Orthotics Group LLC | Prosthetic/Orthotic Supplier | 3647 Clifty Dr, Madison, IN 47250-1649 | 2020-06-23 |
1154941557 | Radiance Renewed | Prosthetic/Orthotic Supplier | 9445 Indianapolis Blvd Ste 1042, Highland, IN 46322-2648 | 2020-04-26 |
1295397735 | Orthopedic and Sports Medicine Center of Northern Indiana, Inc | Prosthetic/Orthotic Supplier | 200 E Jackson Blvd Ste 130, Elkhart, IN 46516-3513 | 2019-07-05 |
1710465166 | Cranial Technologies Inc | Prosthetic/Orthotic Supplier | 10603 N Meridian St Ste 120, Indianapolis, IN 46290-1055 | 2018-07-29 |
1285135913 | Excel Orthotics and Prosthetics LLC | Prosthetic/Orthotic Supplier | 3200 Sycamore Ct Ste 2b, Columbus, IN 47203-1552 | 2018-02-27 |
1003326174 | Bionic Prosthetics and Orthotics Group LLC | Prosthetic/Orthotic Supplier | 3130a Windsor Ct, Elkhart, IN 46514-5556 | 2017-10-03 |
1285144352 | Bionic Prosthetics and Orthotics Group LLC | Prosthetic/Orthotic Supplier | 1101 Glendale Blvd Ste 105, Valparaiso, IN 46383-3769 | 2017-10-03 |
1669904579 | Jordan Poynter | Prosthetic/Orthotic Supplier | 3708 S Lafountain St, Kokomo, IN 46902-3805 | 2017-03-30 |
1184156101 | Shawn Dee Brown | Prosthetic/Orthotic Supplier | 2410 N Glendale Dr Ste C, Fort Wayne, IN 46804-8909 | 2017-03-29 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.