NPI 1649386293

Orthotic & Prosthetic Health

Organisation Prosthetic/Orthotic Supplier Detroit Lakes, MN

Practice location

Address: 214 Front St W, Detroit Lakes, MN 56501-3020
Phone: (218) 847-6767
Fax: (218) 847-7676
Mailing address: 810 S Maple St, Watertown, SD 57201

Authorised official

Name: Robert E Johansen
Title: President
Phone: (218) 847-6767

Registered specialties

Prosthetic/Orthotic Supplier Primary

Suppliers Taxonomy 335E00000X Licence CO1105 (MN)

Other Prosthetic/Orthotic Supplier providers in Minnesota →

Registry record

NPI: 1649386293
Entity type: Organization
NPI issued: 23 Aug 2006
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.