Provider Demographics
NPI:1295200558
Name:MOBILITY PROSTHETICS, LLC
Entity Type:Organization
Organization Name:MOBILITY PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GREER
Authorized Official - Suffix:
Authorized Official - Credentials:CP, BOCO
Authorized Official - Phone:801-997-1367
Mailing Address - Street 1:480 E WINCHESTER ST STE 275
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-7588
Mailing Address - Country:US
Mailing Address - Phone:801-997-1367
Mailing Address - Fax:801-997-1367
Practice Address - Street 1:480 E WINCHESTER ST STE 275
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7588
Practice Address - Country:US
Practice Address - Phone:801-997-1367
Practice Address - Fax:801-997-1367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty