| NPI | 1750480901 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY PETER SANTULLI President 770-339-1190 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 225000000X Orthotic Fitter (Licence: MD C49737) |
| 222Z00000X Orthotist (Licence: GA 13) | |
| 224L00000X Pedorthist (Licence: DE CPed2905) | |
| 224L00000X Pedorthist (Licence: DE CPed1966) | |
| 224900000X Mastectomy Fitter (Licence: DE CFm01708) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2015-09-30 |