Provider Demographics
NPI:1073030623
Name:MOBILE PROSTHETICS & ORTHOTICS, INC.
Entity Type:Organization
Organization Name:MOBILE PROSTHETICS & ORTHOTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-245-7770
Mailing Address - Street 1:3160 SOUTHGATE COMMERCE BLVD STE 38
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-8557
Mailing Address - Country:US
Mailing Address - Phone:407-245-7770
Mailing Address - Fax:407-245-7727
Practice Address - Street 1:4809 MEMORIAL HWY STE 100
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-7515
Practice Address - Country:US
Practice Address - Phone:386-245-7770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-24
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001590300Medicaid