Provider Demographics
NPI:1922376409
Name:ACTIVLIFE MEDICAL MOBILITY
Entity Type:Organization
Organization Name:ACTIVLIFE MEDICAL MOBILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARFORI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-422-6252
Mailing Address - Street 1:7021 ROCK CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-3643
Mailing Address - Country:US
Mailing Address - Phone:240-422-6252
Mailing Address - Fax:301-473-5103
Practice Address - Street 1:8536 DAKOTA DR
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-4138
Practice Address - Country:US
Practice Address - Phone:240-422-6252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14428454332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies