| NPI | 1629722889 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAKE COBURN DAVIS Owner/Clinical Manager 801-820-0045 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Additional Taxonomies | 222Z00000X Orthotist |
| 224P00000X Prosthetist | |
| Enumeration Date | 2022-02-07 |
| Last Update Date | 2022-12-09 |