Provider Demographics
NPI:1558786475
Name:ORTHOPAEDIC MOBILITY RENTAL
Entity Type:Organization
Organization Name:ORTHOPAEDIC MOBILITY RENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANZANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-340-8961
Mailing Address - Street 1:7023 ROGUE FOREST LN
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-1698
Mailing Address - Country:US
Mailing Address - Phone:571-340-8961
Mailing Address - Fax:
Practice Address - Street 1:7023 ROGUE FOREST LN
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-1698
Practice Address - Country:US
Practice Address - Phone:571-340-8961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00000000332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies