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 |