| NPI | 1952847592 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLETTE SHRADER Owner 210-802-8313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2017-01-06 |
| Last Update Date | 2020-07-21 |