Healthcare Provider Details

I. General information

NPI: 1710363486
Provider Name (Legal Business Name): MOTILITY MLK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2015
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 HILL ST
HOT SPRINGS AR
71901-6238
US

IV. Provider business mailing address

PO BOX 1966
HOT SPRINGS AR
71902-1966
US

V. Phone/Fax

Practice location:
  • Phone: 501-620-4800
  • Fax: 848-272-8975
Mailing address:
  • Phone: 501-620-4800
  • Fax: 848-272-8975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberCP2198
License Number StateAR

VIII. Authorized Official

Name: GREG JOHNSON
Title or Position: CERTIFIED PROSTHETIST ORTHOTIST
Credential: CPO
Phone: 479-305-9374