| NPI | 1962839555 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DWAN DIAZ Cc 813-560-8157 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 225100000X Physical Therapist |
| 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment | |
| Enumeration Date | 2013-09-27 |
| Last Update Date | 2022-11-30 |