| NPI | 1801315650 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA ANN WAGNER President 651-426-9388 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2017-09-13 |
| Last Update Date | 2017-10-25 |