| NPI | 1194972158 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY RYAN FREDRICK Owner 850-656-3599 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: FL POR28) |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2014-06-03 |