| NPI | 1255513776 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD WILSON CONREY Owner/Prosthetist 954-584-1954 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: FL POR150) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier (Licence: FL POR190) |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2007-11-27 |