| NPI | 1700463049 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANTINA WILSON Owner 813-324-0180 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1744P3200X Specialist, Prosthetics Case Management |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment | |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2021-03-24 |