Provider Demographics
NPI:1104936202
Name:MOBILITY BY DESIGN LLC
Entity type:Organization
Organization Name:MOBILITY BY DESIGN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:RESOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-338-9094
Mailing Address - Street 1:3010 YORK RD
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-8240
Mailing Address - Country:US
Mailing Address - Phone:717-338-9094
Mailing Address - Fax:717-338-2099
Practice Address - Street 1:3010 YORK RD
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-8240
Practice Address - Country:US
Practice Address - Phone:717-338-9094
Practice Address - Fax:717-338-2099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000005723332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019043440002Medicaid
4252270001Medicare ID - Type Unspecified