Xtreme Prosthetics, LLC.

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

XTREME PROSTHETICS, LLC.

Doing business as

ForMotion Clinic

Practice address

1005 West Columbia St
Suite B
Somerset, KY 42503

Phone

(606) 451-0668

Fax

(606) 451-0078

NPI assigned

Dec 30, 2010

Organization subpart

No

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

Authorized official

Name

Bradford Neil Gardner

Title

Director

Phone

(615) 864-8783

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 2

• ForMotion Clinic Doing business as
• Xtreme Prosthetics & Orthotics, LLC Former legal business name

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

Other NPIs with the same Medicare PAC ID 2

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

• Xtreme Prosthetics LLC.

  dba ForMotion Clinic

  • Prosthetic/Orthotic Supplier
  • Glasgow, KY
  • NPI 1992249718

  7214125657

  Same PAC ID
• Xtreme Prosthetics, LLC.

  dba Bulow Orthotic and Prosthetic Solutions

  • Prosthetic/Orthotic Supplier
  • Bowling Green, KY
  • NPI 1225703838

  7214125657

  Same PAC ID

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

Tax ID family

Formotion Clinic3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Xtreme Prosthetics LLC.

  dba ForMotion Clinic

  • Prosthetic/Orthotic Supplier
  • Glasgow, KY
  • NPI 1992249718
  NPD tax ID
• Xtreme Prosthetics, LLC.

  dba Bulow Orthotic and Prosthetic Solutions

  • Prosthetic/Orthotic Supplier
  • Bowling Green, KY
  • NPI 1225703838
  NPD tax ID

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

{
    "created_epoch": "1293667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780012800000",
    "number": "1245534585",
    "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": "1005 WEST COLUMBIA ST",
            "address_2": "SUITE B",
            "city": "SOMERSET",
            "state": "KY",
            "postal_code": "42503",
            "telephone_number": "606-451-0668",
            "fax_number": "606-451-0078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "XTREME PROSTHETICS, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-30",
        "last_updated": "2026-05-29",
        "certification_date": "2026-05-29",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "BRADFORD",
        "authorized_official_middle_name": "NEIL",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "615-864-8783"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "6469320001",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1245534585",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ForMotion Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Xtreme Prosthetics & Orthotics, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Rhonda L. Wright, BS
• Ronald Wright
• Suzanne Wright, LCSW
• Mary Catherine Wurth, DMD
• Tressa Ann Wyatt, CSA
• Daniel Robert Yanicko Jr., MD
• Vanessa J Yearta
• Ashley Young
• Christopher S Young, LPCA
• Natosha Young

• Prosthetic/Orthotic Supplier in Somerset, KY
• Providers in Somerset, KY by specialty
• Prosthetic/Orthotic Supplier in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 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.