Provider Demographics
NPI:1912778630
Name:MOBILITY CENTER OF WYOMING LLC
Entity Type:Organization
Organization Name:MOBILITY CENTER OF WYOMING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:LEE SOUTH
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:208-596-6834
Mailing Address - Street 1:2100 E CEDAR ST STE H
Mailing Address - Street 2:
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-6012
Mailing Address - Country:US
Mailing Address - Phone:307-417-0498
Mailing Address - Fax:307-316-0967
Practice Address - Street 1:2100 E CEDAR ST STE H
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-6012
Practice Address - Country:US
Practice Address - Phone:307-417-0498
Practice Address - Fax:307-316-0967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies