Healthcare Provider Details

I. General information

NPI: 1124022959
Provider Name (Legal Business Name): ABILITY BIOMECHANICS INT'L INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 11/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6190 FAIRMOUNT AVE SUITE A
SAN DIEGO CA
92120-3428
US

IV. Provider business mailing address

6190 FAIRMOUNT AVE SUITE A
SAN DIEGO CA
92120-3428
US

V. Phone/Fax

Practice location:
  • Phone: 619-285-5040
  • Fax: 619-285-5045
Mailing address:
  • Phone: 619-285-5040
  • Fax: 619-285-5045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA0900X
TaxonomyAmputee Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN E PRATER
Title or Position: OFFICE MANAGER
Credential:
Phone: 619-285-5040