LISA E ROSTVOLD NPI 1558539338

NPI Information

  • NPI: 1558539338
  • Provider Name: LISA E ROSTVOLD
  • Classification: Prosthetic/Orthotic Supplier - 335E00000X
  • Entity Type: Organization
  • Doing Business As: BLUE MOON SHOES
  • Address: 110 N BUFFALO ST
    WARSAW, IN
    ZIP 46580
  • Phone: (574) 267-5537

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NPI Details

LISA E ROSTVOLD is a prosthetic orthotic supplier in Warsaw, IN. 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. LISA E ROSTVOLD NPI is 1558539338. The provider is registered as an organization entity type.
The provider Is Doing Business As Blue Moon Shoes.

The provider's business location address is:

110 N BUFFALO ST
WARSAW, IN
ZIP 46580-754
Phone: (574) 267-5537
Fax: (574) 267-6165

The provider's authorized official is Lisa Ellen Rostvold .
The authorized official title is Owner and has the following contact phone number (574) 267-5537.

The enumeration date for this NPI number is 2/14/2008 and was last updated on 6/19/2008.

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:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1335E00000XProsthetic/Orthotic SupplierCPED2624INDIANAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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