| NPI | 1962014100 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANDRE SHONDALE MOSTELLA Owner 225-316-5444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Additional Taxonomies | 1744P3200X Specialist, Prosthetics Case Management |
| 222Z00000X Orthotist | |
| 224P00000X Prosthetist | |
| Enumeration Date | 2020-08-19 |
| Last Update Date | 2023-09-06 |