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Provider Code Request Form

There are two ways to obtain a provider code.

First, you can contact your O & P care facility and ask for their Knit-Rite Direct Provider Code.

If your Orthotics or Prosthetic Provider does not have a Knit-Rite Direct Provider Code, you can request that they be contacted to receive a Provider Code. Complete the form below and a Knit-Rite Direct Customer Service Representative will contact your provider, set them up with a Provider Code and contact you. Please allow 5-7 business days for a reply.  

First Name:
 
Last Name:
 
Email Address:
 
Phone #:
 
State / Country Where You Live:
 
Your Provider's Name:
 
Your Provider's Facility Name or Practice Name:
 
Your Provider's Phone Number:
 
Comments / Questions:
 


How would you like us to contact you? Phone     E-Mail

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