Provider Demographics
NPI:1073904603
Name:ACTIVE ORTHOTICS & PROSTHETICS, LLC
Entity Type:Organization
Organization Name:ACTIVE ORTHOTICS & PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:WEIKERT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:814-231-0451
Mailing Address - Street 1:1333 S ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-5944
Mailing Address - Country:US
Mailing Address - Phone:814-231-0451
Mailing Address - Fax:814-231-1817
Practice Address - Street 1:1333 S ALLEN ST
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-5944
Practice Address - Country:US
Practice Address - Phone:814-231-0451
Practice Address - Fax:814-231-1817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthistGroup - Single Specialty