| NPI | 1770751950 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE B MITTENDORF Owner 817-594-5868 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier (Licence: TN CFm01117) |
| Enumeration Date | 2008-02-11 |
| Last Update Date | 2022-09-08 |