Provider Demographics
NPI:1043211378
Name:MOBILITY PROSTHETICS & ORTHOTICS INC
Entity Type:Organization
Organization Name:MOBILITY PROSTHETICS & ORTHOTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT CO OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:BOCPO CPO
Authorized Official - Phone:606-928-1529
Mailing Address - Street 1:PO BOX 675
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-0675
Mailing Address - Country:US
Mailing Address - Phone:606-928-1529
Mailing Address - Fax:606-928-1549
Practice Address - Street 1:1338 CANNONSBURG RD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-7914
Practice Address - Country:US
Practice Address - Phone:606-928-1529
Practice Address - Fax:606-928-1549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
5378190001Medicare ID - Type Unspecified