Organization
ACTIVE MOBILITY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLARENCE R HOOPER JR. CPO (CEO)
(843) 577-9577
Entity
Organization
Contact information
Practice address
18 LEINBACH DR, UNIT E, CHARLESTON, SC 29407-7916
(843) 377-0847
(843) 377-0845
Mailing address
3465 W MONTAGUE AVE STE 101, N CHARLESTON, SC 29418-5938
(843) 577-9577
(843) 577-9574
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
010714845
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DE2440
—
SC
Enumeration date
01/30/2006
Last updated
08/09/2012
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