| NPI | 1043667025 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COREY PENA Owner/Certified Orthotist 980-781-1521 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 222Z00000X Orthotist |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2016-09-21 |