NPI 1114902665

The Custom Source INC

Organisation Prosthetic/Orthotic Supplier Matthews, NC

Practice location

Address: 1013 Chestnut Ln STE 120, Matthews, NC 28104-8567
Phone: (704) 893-5457
Fax: (704) 973-0696

Authorised official

Name: Kasey Rolfes
Title: Operations Manager
Phone: (704) 893-5457

Registered specialties (3)

Prosthetic/Orthotic Supplier Primary

Suppliers Taxonomy 335E00000X

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Orthotist

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 222Z00000X

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Durable Medical Equipment & Medical Supplies

Suppliers Taxonomy 332B00000X

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Registry record

NPI: 1114902665
Entity type: Organization
NPI issued: 7 Dec 2005
Record last updated: 21 Jul 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.