Provider Demographics
NPI:1285258996
Name:MOBILITY PROSTHETIC AND ORTHOTIC SERVICES LLC
Entity type:Organization
Organization Name:MOBILITY PROSTHETIC AND ORTHOTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAJU
Authorized Official - Middle Name:
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, LPO
Authorized Official - Phone:714-390-7533
Mailing Address - Street 1:1921 MOTOR AVE STE B
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4185
Mailing Address - Country:US
Mailing Address - Phone:928-377-4125
Mailing Address - Fax:928-277-4400
Practice Address - Street 1:1921 MOTOR AVE STE B
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4185
Practice Address - Country:US
Practice Address - Phone:928-377-4125
Practice Address - Fax:928-277-4400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier