| NPI | 1104206499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY LEWIS EVP Of Licensure 512-806-2756 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NC 02286) |
| 224P00000X Prosthetist | |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment | |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2025-10-22 |