Organization
VITAL PROSTHETICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DALE E PETERSEN JR. CP (PRES/OWNER)
(850) 526-0063
Entity
Organization
Contact information
Practice address
4299 3RD AVE, MARIANNA, FL 32446-2136
(850) 526-0063
(850) 526-1317
Mailing address
PO BOX 430, MARIANNA, FL 32447-0430
(850) 526-0063
(850) 526-1317
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
PRO 66
FL
Other
Enumeration date
06/26/2008
Last updated
09/18/2008
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