| NPI | 1497793830 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE B. MITTENDORF Owner And Operator 817-594-5868 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2022-09-08 |