| NPI | 1750331484 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY RUSSALESI Cco 484-246-9499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: DE 2005212034) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: DE 332BX2000X) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2025-10-14 |