| NPI | 1588117055 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE SMITH Owner 850-474-5003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: FL PED207) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier (Licence: FL ORF234) |
| Enumeration Date | 2016-08-01 |
| Last Update Date | 2017-06-14 |