Provider Demographics
NPI:1316475114
Name:WEATHERLY MOBILITY ENTERPRISES, LLC
Entity type:Organization
Organization Name:WEATHERLY MOBILITY ENTERPRISES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:CLYCE
Authorized Official - Last Name:WEATHERLY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:901-779-4199
Mailing Address - Street 1:3840 VISCOUNT AVE STE 14
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-6023
Mailing Address - Country:US
Mailing Address - Phone:901-779-4199
Mailing Address - Fax:
Practice Address - Street 1:3840 VISCOUNT AVE STE 14
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-6023
Practice Address - Country:US
Practice Address - Phone:901-779-4199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment