THE CUSTOM SOURCE INC NPI 1114902665

NPI Information

THE CUSTOM SOURCE INC is a prosthetic orthotic supplier in Matthews, NC. The provider is 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. THE CUSTOM SOURCE INC NPI is 1114902665. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1013 CHESTNUT LN STE 120
MATTHEWS, NC
ZIP 28104-567
Phone: (704) 893-5457
Fax: (704) 973-0696

The provider's authorized official is Kasey Rolfes .
The authorized official title is Operations Manager and has the following contact phone number (704) 893-5457.

The enumeration date for this NPI number is 12/7/2005 and was last updated on 9/25/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

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