Provider Demographics
NPI:1659361202
Name:MOBILITY REHAB PRODUCTS, LLC
Entity Type:Organization
Organization Name:MOBILITY REHAB PRODUCTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MYZAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-833-2603
Mailing Address - Street 1:1106 BUSINESS PARKWAY SOUTH
Mailing Address - Street 2:A-1
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157
Mailing Address - Country:US
Mailing Address - Phone:410-833-2603
Mailing Address - Fax:410-833-2640
Practice Address - Street 1:1106 BUSINESS PARKWAY SOUTH
Practice Address - Street 2:A-1
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157
Practice Address - Country:US
Practice Address - Phone:410-833-2603
Practice Address - Fax:410-833-2640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06013861332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1259030001OtherPTAN