| NPI | 1427564020 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANICE MOORE Owner 863-212-6008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1744P3200X Specialist, Prosthetics Case Management |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier (Licence: FL clo210755) |
| Enumeration Date | 2017-12-18 |
| Last Update Date | 2018-03-14 |