| NPI | 1639672744 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE M JOHNSON Owner 262-354-0764 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2018-03-15 |
| Last Update Date | 2021-01-19 |