| NPI | 1043350481 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY R FREDRICK Owner 850-656-3599 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: GA 014) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier (Licence: FL POR 28) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2026-05-18 |