| NPI | 1205305430 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN LUCAS Podiatrist 901-309-8898 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy |
| 291U00000X Clinical Medical Laboratory | |
| 293D00000X Physiological Laboratory | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 335E00000X Prosthetic/Orthotic Supplier | |
| Enumeration Date | 2018-11-16 |
| Last Update Date | 2020-04-14 |