Provider Demographics
NPI:1124022959
Name:ABILITY BIOMECHANICS INT'L INC
Entity Type:Organization
Organization Name:ABILITY BIOMECHANICS INT'L INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:PRATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-285-5040
Mailing Address - Street 1:6190 FAIRMOUNT AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-3428
Mailing Address - Country:US
Mailing Address - Phone:619-285-5040
Mailing Address - Fax:619-285-5045
Practice Address - Street 1:6190 FAIRMOUNT AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-3428
Practice Address - Country:US
Practice Address - Phone:619-285-5040
Practice Address - Fax:619-285-5045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0900XAmbulatory Health Care FacilitiesClinic/CenterAmputee
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGXC000630Medicaid
CA4204050001Medicare NSC