| NPI | 1407492671 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TASHA GLEASON Owner 715-203-5730 |
| Organization Subpart ? | No |
| Primary Taxonomy | 224L00000X Pedorthist |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2019-11-22 |
| Last Update Date | 2020-01-23 |