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The Custom Source Inc
Prosthetic/Orthotic Supplier in Matthews, North Carolina
NPI 1114902665

The Custom Source Inc is a Prosthetic/Orthotic Supplier based in Matthews, NC. The Custom Source Inc practices in Matthews, NC. The NPI Number for The Custom Source Inc is 1114902665 and holds a License No. (North Carolina).

The current practice location address for The Custom Source Inc is 1013 Chestnut Ln Ste 120, Matthews, NC and can be reached out via phone at 704-893-5457 and via fax at 704-973-0696.

Location: 1013 Chestnut Ln Ste 120, Matthews, NC, 28104-8567
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1114902665
Provider Name
The Custom Source Inc
Credential
Provider Entity Type
Organization
Address
1013 Chestnut Ln Ste 120, Matthews, NC, 28104-8567
Phone Number
704-893-5457
Fax Number
704-973-0696
Provider Enumeration Date
12/07/2005
Last Update Date
03/08/2024
tick
Provider's Legacy Identifiers
Identifier Type State Issuer
0491E 01 BC/BS/NC
7700578 05 NC
institution
Provider Business Practice Location Address Details
Address
1013 Chestnut Ln Ste 120
City
Matthews
State
North Carolina
Zip
28104-8567
Phone Number
704-893-5457
Fax Number
704-973-0696
person
Provider Business Mailing Address Details
Address
1013 Chestnut Ln Ste 120
City
Matthews
State
North Carolina
Zip
28104-8567
Phone Number
704-893-5457
Fax Number
704-973-0696
person
Provider's Taxonomy Details 1
Type
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Classification
Orthotist
Speciality
-
Taxonomy
222Z00000X
License No.
()
Definition
A health care professional who is specifically educated and trained to manage comprehensive orthotic patient care, including musculoskeletal and neuromuscular anomalies resulting from injuries or disease processes involving the lower extremity, upper extremity or spinal segment/s and positional deformation of the cranium. Orthotists assess specific patient needs, formulate an appropriate treatment plan, implement the treatment plan and provide follow-up care.
person
Provider's Taxonomy Details 2
Type
Suppliers
Classification
Durable Medical Equipment & Medical Supplies
Speciality
-
Taxonomy
332B00000X
License No.
()
Definition
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.
person
Provider's Taxonomy Details 3
Type
Suppliers
Classification
Prosthetic/Orthotic Supplier
Speciality
-
Taxonomy
335E00000X
License No.
()
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.
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