| NPI | 1730815184 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRETT PUCKETT Md 904-634-0640 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| 335E00000X Prosthetic/Orthotic Supplier | |
| Enumeration Date | 2022-07-28 |
| Last Update Date | 2025-05-24 |