NPIMap

Organization Active NPI

SRT Prosthetics & Orthotics LLC

Doing business as ForMotion Clinic

  • Prosthetic/Orthotic Supplier
  • Fort Wayne, IN
National Provider Identifier
1508804295
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
Doing business as
ForMotion Clinic
Practice address
3818 W Jefferson Blvd
Fort Wayne, IN 46804-6840
Phone
(260) 432-8886
Fax
(260) 432-1137
NPI assigned
Jun 3, 2006
Last updated
Feb 23, 2026By the provider in NPPES
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
Bradford Neil Gardner
Title
Director
Phone
(615) 864-8783

Specialties & licenses 1

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

Addresses

Primary practice location

3818 W Jefferson Blvd
Fort Wayne, IN 46804-6840

Mailing address

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

Other identifiers 3

IdentifierTypeStateIssuer
200360760MedicaidIN
000000229696OtherINANTHEM
21825OtherINABP

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
O20100930054243 IN DME Supplier - Prosthetic PersonnelDME Supplier - Orthotic Personnel 7618189077 Practice locations: Fort Wayne, 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 LLC3818 W Jefferson Blvd, Fort Wayne, IN 46804-6840(260) 432-8886 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.

Locations

3818 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 432-8886

4109 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 432-8886

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1771804800000",
    "number": "1508804295",
    "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": "3818 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046840",
            "telephone_number": "260-432-8886",
            "fax_number": "260-432-1137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SRT PROSTHETICS & ORTHOTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-03",
        "last_updated": "2026-02-23",
        "certification_date": "2026-02-23",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200360760",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000229696",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ABP",
            "identifier": "21825",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ForMotion Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Wayne, 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.