| NPI | 1467953653 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN WESLEY PETTIT Owner/Prosthetic Practitioner 817-649-8144 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: TX 101595) |
| Enumeration Date | 2018-02-23 |
| Last Update Date | 2018-02-23 |