Organization
ACTIVE LIFE ORTHOTICS AND PROSTHETICS CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PALLAVI NEMANI (COMPLIANCE OFFICER)
(512) 552-6311
Entity
Organization
Contact information
Practice address
124 ALVARADO DR SE, ALBUQUERQUE, NM 87108-2940
(505) 266-1700
(505) 349-5170
Mailing address
124 ALVARADO DR SE, ALBUQUERQUE, NM 87108-2940
(505) 266-1700
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
06/10/2019
Last updated
12/14/2023
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