ACTIVE LIFE ORTHOTICS AND PROSTHETICS CORP (NPI# 1891354197) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891354197 |
| Entity Type | Organization |
| Organization Name | ACTIVE LIFE ORTHOTICS AND PROSTHETICS CORP |
| Practice Address |
124 Alvarado Dr Se Albuquerque NM 87108-2940 |
| Practice Telephone | 5052661700 |
| Practice Fax Number | 5053495170 |
| Mailing Telephone | 5052661700 |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2020-01-10 |
| Authorized Official Name | MR. DONALD DEANE DOTY (CLINICAL DIRECTOR) |
| Authorized Official Telephone | 8185216837 |
| Authorized Official Credential | CPO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 335E00000X | Prosthetic/Orthotic Supplier | Suppliers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083254528 | Active Life Orthotics and Prosthetics Corp | Prosthetic/Orthotic Supplier | 3811 E Bell Rd Ste 112, Phoenix, AZ 85032-2158 | 2020-01-13 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | ACTIVE LIFE ORTHOTICS AND PROSTHETICS CORP. | 2515 N Kentucky Ave, Roswell, NM 88201-5807 |
| Street Address |
124 ALVARADO DR SE |
| City | ALBUQUERQUE |
| State | NM |
| Zip Code | 87108-2940 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740236819 | Active Life Inc | Prosthetic/Orthotic Supplier | 124 Alvarado Dr Se, Albuquerque, NM 87108-2940 | 2006-05-26 |
| 1679097117 | Ryder Doty | Orthotic Fitter | 124 Alvarado Dr Se, Albuquerque, NM 87108-2940 | 2017-07-26 |
| 1013244995 | Medical Consulting Media, Inc. | Prosthetic/Orthotic Supplier | 124 Alvarado Dr Se, Albuquerque, NM 87108-2940 | 2009-11-12 |
| 1588827034 | Donald Deane Doty Jr. | Specialist | 124 Alvarado Dr Se, Albuquerque, NM 87108-2940 | 2008-07-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588274393 | Aubrey Bunnenberg | Behavior Technician | 114 Pennsyvlania St. Ne Apt. 1, Albuquerque, NM 87108 | 2020-08-06 |
| 1336757301 | Dailey Doss | Physician Assistant | Raymond G. Murphy Va Medical Center, 1501 San Pedro Se, Albuquerque, NM 87108 | 2020-07-16 |
| 1457990046 | Christine Lovato | Registered Nurse | Albuquerque Treatment Services LLC, 123 Madeira Dr Se, Albuquerque, NM 87108 | 2019-12-30 |
| 1265074405 | Andrew Jacob Reuter | Pharmacist | 3816 Copper Ave Ne, Unit A, Albuquerque, NM 87108 | 2019-10-09 |
| 1518517325 | Lillian Abeyta | Technician | 1501 San Pedro Dr Se., Albuquerque, NM 87108 | 2019-09-13 |
| 1962970061 | Donald Borrego | Occupational Therapy Assistant | 5200 Copper Ne, #7, Albuquerque, NM 87108 | 2018-11-06 |
| 1154808012 | Catalina Castro | Social Worker | 209 San Pablo Se, Albuquerque, NM 87108 | 2018-07-24 |
| 1942721048 | Walgreen Co | Pharmacy | 933 San Mateo Blvd Ne Ste 501, Albuquerque, NM 87108 | 2017-06-29 |
| 1467981860 | Jennifer Martinez | Behavior Technician | 628 Espanola Se, Albuquerque, NM 87108 | 2017-06-08 |
| 1457892465 | J Dowd Counseling LLC | Counselor | 514 Monroe Street Se, Albuquerque, NM 87108 | 2017-03-10 |
| Find all providers in zip 87108 | ||||
| Taxonomy Code | 335E00000X |
| Grouping | Suppliers |
| Classification | Prosthetic/Orthotic Supplier |
| An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700347358 | Capitol Orthopedic Inc | Prosthetic/Orthotic Supplier | 401 Alvarado Dr Se Ste C, Albuquerque, NM 87108-2939 | 2019-03-27 |
| 1831653831 | Rio Grande Orthotics and Prosthetics | Prosthetic/Orthotic Supplier | 4824 Mcmahon Blvd Nw Ste 112, Albuquerque, NM 87114-5412 | 2019-01-24 |
| 1336613298 | Mid Star Lab Inc | Prosthetic/Orthotic Supplier | 401 Alvarado Dr Se, Albuquerque, NM 87108-2939 | 2019-01-14 |
| 1548679897 | Functional Orthotics & Prosthetics | Prosthetic/Orthotic Supplier | 5111 Juan Tabo Blvd Ne Ste A, Albuquerque, NM 87111-2672 | 2014-08-11 |
| 1104187855 | Lower Extremity International LLC | Prosthetic/Orthotic Supplier | 9428 Lexington Ave Ne Suite E, Albuquerque, NM 87112-1375 | 2012-05-30 |
| 1639488588 | Estetica De Ella Salon (cranial Prosthesis) | Prosthetic/Orthotic Supplier | 2510 San Mateo Pl Ne, Albuquerque, NM 87110-4064 | 2010-09-27 |
| 1528276318 | Albuquerque Orthotics & Prosthetics | Prosthetic/Orthotic Supplier | 4909 Ellison St Ne, Suite A, Albuquerque, NM 87109-4331 | 2007-05-18 |
| 1740236819 | Active Life Inc | Prosthetic/Orthotic Supplier | 124 Alvarado Dr Se, Albuquerque, NM 87108-2940 | 2006-05-26 |
| 1902883473 | Prosthetic Orthotic Specialists, Inc | Prosthetic/Orthotic Supplier | 5095 Ellison St Ne, Albuquerque, NM 87109-4326 | 2005-12-27 |
| 1528506821 | Active Life Orthotics and Prosthetics Corp. | Prosthetic/Orthotic Supplier | 6211 San Mateo Blvd Ne, Suite 150, Albuquerque, NM 87109-3533 | 2017-02-07 |
| Find all providers in ALBUQUERQUE | ||||
| City | ALBUQUERQUE |
| Zip Code | 87108 |
Please comment or provide details below to improve the information on ACTIVE LIFE ORTHOTICS AND PROSTHETICS CORP.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.