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General NPI Number Information
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NPI Number | 1114002219
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Entity Type | Organization
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Legal Business Name | GALLUP LIMB AND BRACE CO INC
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 01/25/2024
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Provider Practice Location Address
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Address Line | 927 WEST AZTEC AVENUE
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City | GALLUP
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State | NM
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Zip | 87301
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Country | US
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Telephone | 505-722-5756
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Fax | 505-722-6726
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Provider Business Mailing Address
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Address Line | 927 WEST AZTEC AVENUE
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City | GALLUP
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State | NM
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Zip | 87301
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Country | US
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Telephone | 505-722-5756
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Fax | 505-722-6726
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | JUSTIN MARSHALL
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Credential | ABC COA
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Telephone | 505-722-5756
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number | CP002174
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License Number State |
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