Healthcare Provider Details

I. General information

NPI: 1871745653
Provider Name (Legal Business Name): ACTIVE FEET, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2008
Last Update Date: 11/12/2022
Certification Date: 11/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5490 COMPLEX ST STE 605
SAN DIEGO CA
92123-1126
US

IV. Provider business mailing address

5490 COMPLEX ST STE 605
SAN DIEGO CA
92123-1126
US

V. Phone/Fax

Practice location:
  • Phone: 858-453-5057
  • Fax: 858-453-5058
Mailing address:
  • Phone: 858-453-5057
  • Fax: 858-453-5058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. PHILIP LARKINS
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 858-453-5057