Provider Demographics
NPI:1962912931
Name:ACTIVE MOBILITY, LLC
Entity type:Organization
Organization Name:ACTIVE MOBILITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOTIST/PROSTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:207-749-3789
Mailing Address - Street 1:639 BLACKSTRAP RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-2488
Mailing Address - Country:US
Mailing Address - Phone:207-749-3789
Mailing Address - Fax:
Practice Address - Street 1:14 THOMAS POINT RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3911
Practice Address - Country:US
Practice Address - Phone:207-607-4297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-04
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Single Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty