| NPI | 1356598478 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY RYAN FREDRICK Owner 850-656-3599 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: GA 14) |
| Enumeration Date | 2008-08-20 |
| Last Update Date | 2014-06-03 |