| NPI | 1376006734 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID B ROTTER CEO 815-714-2932 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 222Z00000X Orthotist |
| 224L00000X Pedorthist | |
| 224P00000X Prosthetist | |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment | |
| 335E00000X Prosthetic/Orthotic Supplier | |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2019-12-02 |