| NPI | 1720467004 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN FALLIS Dpm/Owner 859-341-2440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2020-01-29 |