| NPI | 1902399942 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEZAREE' LUSK Owner 469-499-6200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 1744P3200X Specialist, Prosthetics Case Management (Licence: TX 1449535) |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2023-12-15 |