NPIMap

Organization Active NPI

SRT Prosthetics & Orthotics LLC

  • Prosthetic/Orthotic Supplier
  • Muncie, IN
National Provider Identifier
1134417009
Registry record updated Feb 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
SRT PROSTHETICS & ORTHOTICS LLC
Practice address
3301 W Bethel Ave
Muncie, IN 47304-5402
Phone
(419) 633-3961
Fax
(419) 633-3981
NPI assigned
Jul 13, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Leslie Siebenaler
Title
Director of Operations
Phone
(866) 633-3961

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetic/Orthotic Supplier 335E00000X Primary

Addresses

Primary practice location

3301 W Bethel Ave
Muncie, IN 47304-5402

Mailing address

102 Woodmont Blvd Ste 400
Nashville, TN 37205-5217
Phone (615) 550-8774

Other identifiers 1

IdentifierTypeStateIssuer
200360760GMedicaidIN

Other names 1

  • ForMotion Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121001000195 IN DME Supplier - Prosthetic PersonnelDME Supplier - Orthotic Personnel 7618189077 Practice locations: Muncie, IN

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
SRT Prosthetics & Orthotics LLC3301 W Bethel Ave, Muncie, IN 47304-5402(765) 896-9389 Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Limb Prostheses|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom|Lymphedema Compression Treatment Items Does not accept assignmentParticipating since Feb 14, 2002

National Provider Directory

National Provider Directory
Tax ID family
SRT Prosthetics Orthotics LLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1310515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1771804800000",
    "number": "1134417009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 WOODMONT BLVD STE 400",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372055217",
            "telephone_number": "615-550-8774",
            "fax_number": "615-454-5352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3301 W BETHEL AVE",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473045402",
            "telephone_number": "419-633-3961",
            "fax_number": "419-633-3981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SRT PROSTHETICS & ORTHOTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-13",
        "last_updated": "2026-02-23",
        "certification_date": "2026-02-23",
        "status": "A",
        "authorized_official_last_name": "SIEBENALER",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "866-633-3961"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200360760G",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ForMotion Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Muncie, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.