| NPI | 1932742079 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA RYAN FANN Managing Owner 615-579-8407 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Additional Taxonomies | 224P00000X Prosthetist |
| Enumeration Date | 2019-10-22 |
| Last Update Date | 2023-08-23 |