LISA E ROSTVOLD


Address: 110 N Buffalo St, Warsaw, IN 46580-2754
Phone: 5742675537

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 335E00000X Prosthetic/Orthotic Supplier CPED2624 IN Suppliers

Other Provider/Organization Names

Other Name Type Code
Blue Moon Shoes Doing Business As Name - Organization

Office Location

Street Address 110 N BUFFALO ST
City WARSAW
State IN
Zip Code 46580-2754

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
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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
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Taxonomy Information

Taxonomy Code 335E00000X
Grouping Suppliers
Classification Prosthetic/Orthotic Supplier

Taxonomy Definition

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.

Providers in the same taxonomy and city

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

Providers in the same taxonomy and state

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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Competitor

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City WARSAW
Zip Code 46580

Improve Information

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Dataset Information

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.

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