| NPI | 1194765081 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WADE BADER Owner Practitioner 813-962-6100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: FL POR53) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: FL POR53) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2020-08-22 |