| NPI | 1558539338 |
|---|---|
| Doing Business As | BLUE MOON SHOES |
| Entity Type | Organization |
| Authorized Contact | LISA ELLEN ROSTVOLD Owner 574-267-5537 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: IN CPed2624) |
| Enumeration Date | 2008-02-14 |
| Last Update Date | 2008-06-19 |