Provider Demographics
NPI:1508528654
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:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ILEA
Authorized Official - Middle Name:ALEXIS
Authorized Official - Last Name:MATTISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-377-4180
Mailing Address - Street 1:1675 MESQUITE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5665
Mailing Address - Country:US
Mailing Address - Phone:928-680-4089
Mailing Address - Fax:928-680-0089
Practice Address - Street 1:1675 MESQUITE AVE STE A
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5665
Practice Address - Country:US
Practice Address - Phone:928-680-4089
Practice Address - Fax:928-680-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier