Healthcare Provider Details

I. General information

NPI: 1356779367
Provider Name (Legal Business Name): FREEDOM MOBILITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2013
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10515 W MARKHAM ST SOHO CENTRE H6
LITTLE ROCK AR
72205-2297
US

IV. Provider business mailing address

10515 W MARKHAM ST SUITE H6
LITTLE ROCK AR
72205-2297
US

V. Phone/Fax

Practice location:
  • Phone: 501-413-4855
  • Fax:
Mailing address:
  • Phone: 501-413-4855
  • Fax: 866-929-2005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateAR

VIII. Authorized Official

Name: MR. BRYCE MATTHEW WALZER
Title or Position: CEO
Credential: ATP
Phone: 501-413-4855