Healthcare Provider Details

I. General information

NPI: 1205716479
Provider Name (Legal Business Name): THERAMOBIL ORTHOTICS AND PROSTHETICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2025
Last Update Date: 04/26/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 W PERSHING BLVD STE E
NORTH LITTLE ROCK AR
72114-2147
US

IV. Provider business mailing address

505 W PERSHING BLVD STE E
NORTH LITTLE ROCK AR
72114-2147
US

V. Phone/Fax

Practice location:
  • Phone: 479-252-1252
  • Fax:
Mailing address:
  • Phone: 479-252-1252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA FERGUSON
Title or Position: OWNER
Credential: PT
Phone: 479-252-1252