MEDICARE: ACTIVE MOBILITY & DESIGN INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	1507	FL

General Provider Information

NPI Number	:	1265428437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVE MOBILITY & DESIGN INC

Provider Business Mailing Address
First Line	:	6144 S US HIGHWAY 1
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-3951
Country	:	US
Telephone Number	:	772-465-9600
Fax Number	:	772-465-0966

Provider Business Practice Location Address
First Line	:	6144 S US HIGHWAY 1
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-3951
Country	:	US
Telephone Number	:	772-465-9600
Fax Number	:	772-465-0966

Authorized Official
Title or Position	:	SECRETARY/TREASURER
Name	:	MR. WILLIAM D BOWES
Credential	:
Telephone Number	:	772-465-9600

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	08/22/2020

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