Healthcare Provider Details

I. General information

NPI: 1487446985
Provider Name (Legal Business Name): MOBILITY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4809 MEMORIAL HWY STE 200
TAMPA FL
33634-7515
US

IV. Provider business mailing address

4809 MEMORIAL HWY STE 200
TAMPA FL
33634-7515
US

V. Phone/Fax

Practice location:
  • Phone: 813-517-1742
  • Fax:
Mailing address:
  • Phone: 813-517-1742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224L00000X
TaxonomyPedorthist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name: ARLENE GILLIS
Title or Position: PRESIDENT
Credential: LPO, CP
Phone: 813-517-1741