| NPI | 1285758052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATT BOEHM CFO 567-525-2061 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: OH 32900011) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207X00000X Orthopaedic Surgery | |
| 213E00000X Podiatrist | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery | |
| 225100000X Physical Therapist | |
| 225X00000X Occupational Therapist | |
| 363A00000X Physician Assistant | |
| 363AM0700X Physician Assistant, Medical | |
| 363L00000X Nurse Practitioner | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2025-01-15 |