Healthcare Provider Details

I. General information

NPI: 1962912931
Provider Name (Legal Business Name): ACTIVE MOBILITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 11/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 THOMAS POINT RD
BRUNSWICK ME
04011-3911
US

IV. Provider business mailing address

639 BLACKSTRAP RD
FALMOUTH ME
04105-2488
US

V. Phone/Fax

Practice location:
  • Phone: 207-607-4297
  • Fax:
Mailing address:
  • Phone: 207-749-3789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name: MR. STEPHEN TODD HAMILTON
Title or Position: ORTHOTIST/PROSTHETIST
Credential: CPO
Phone: 207-749-3789