Organization
GALLUP LIMB AND BRACE CO INC
Active
Other names
Gallup Artificial Limb and Brace Co Inc
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN MARSHALL ABC COA (PRESIDENT/OWNER)
(505) 722-5756
Entity
Organization
Contact information
Practice address
927 WEST AZTEC AVENUE, GALLUP, NM 87301
(505) 722-5756
(505) 722-6726
Mailing address
927 WEST AZTEC AVENUE, GALLUP, NM 87301
(505) 722-5756
(505) 722-6726
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
CP002174
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
307852
—
AZ
05
—
T6269
—
NM
Enumeration date
10/26/2006
Last updated
01/25/2024
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