NPI age
15 years
Enumerated 2010-06-12
Across 48 active prosthetic/orthotic supplier providers in Idaho.
4 individual providers on file at this primary practice address.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 1659692739 | |
| 01 | 6419450001 | PTAN |
Multi-provider organization. 4 individual providers on file at this primary address.
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