Organization
ACTIVE BRACE AND LIMB LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY ALLEN PIERCE CO (CO-OWNER)
(231) 932-8702
Entity
Organization
Contact information
Practice address
5123 N ROYAL DR, TRAVERSE CITY, MI 49684-9201
(231) 932-8702
Mailing address
5123 N ROYAL DR, TRAVERSE CITY, MI 49684-9201
(231) 932-8702
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BC3200X
Customized Equipment (DME)
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4487817
—
MI
Enumeration date
05/18/2006
Last updated
06/07/2016
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