| NPI | 1639650054 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARRED NATHANIAL GIBSON Owner 541-654-9447 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 224L00000X |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| 335E00000X Prosthetic/Orthotic Supplier | |
| Enumeration Date | 2018-08-23 |
| Last Update Date | 2019-11-07 |