| NPI | 1508686106 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREG JOHNSON Owner/Operator 479-305-9374 |
| Organization Subpart ? | No |
| Primary Taxonomy | 224P00000X Prosthetist |
| Additional Taxonomies | 222Z00000X Orthotist |
| Enumeration Date | 2024-10-16 |
| Last Update Date | 2024-11-13 |