# GALLUP LIMB AND BRACE CO INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Gallup Artificial Limb and Brace Co Inc
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114002219
- **Authorized official:** JUSTIN MARSHALL ABC COA (PRESIDENT/OWNER)
- **Authorized official phone:** (505) 722-5756

## Contact information

- **Practice address:** 927 WEST AZTEC AVENUE, GALLUP, NM 87301
- **Practice address phone:** (505) 722-5756
- **Practice address fax:** (505) 722-6726
- **Mailing address:** 927 WEST AZTEC AVENUE, GALLUP, NM 87301
- **Mailing address phone:** (505) 722-5756
- **Mailing address fax:** (505) 722-6726

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 224P00000X | Prosthetist | CP002174 | — | Yes |

## Other

- **Enumeration date:** 10/26/2006
- **Last updated:** 01/25/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 307852 | — | AZ |
| 05 | — | T6269 | — | NM |