Organization
PROSTHETIC DESIGN INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBORAH J WILSON (OWNER/V.P.)
(314) 535-5359
Entity
Organization
Contact information
Practice address
142 JUNGERMANN ROAD, ST. PETERS, MO 63376
(314) 535-5359
(314) 535-5488
Mailing address
PO BOX 444, BALLWIN, MO 63022
(314) 535-5359
(314) 535-5488
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
17156319
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
624794301
—
MO
Enumeration date
09/15/2008
Last updated
09/15/2008
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