| NPI | 1396135315 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANE EVANS WAKEFIELD Owner 813-605-4610 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: FL POR249) |
| Enumeration Date | 2015-01-28 |
| Last Update Date | 2015-07-27 |