| NPI | 1285872614 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY LEE COOK Certified Pedorthist 314-872-2929 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: MO B00029005) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MO B00029005) |
| Enumeration Date | 2009-01-22 |
| Last Update Date | 2010-05-19 |