Healthcare Provider Details

I. General information

NPI: 1861206146
Provider Name (Legal Business Name): MOBILITY MEDICAL INDIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10744 GARMAN RD
LEO IN
46765-9798
US

IV. Provider business mailing address

10744 GARMAN RD
LEO IN
46765-9798
US

V. Phone/Fax

Practice location:
  • Phone: 260-433-2430
  • Fax:
Mailing address:
  • Phone: 260-999-9115
  • Fax: 260-999-9576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: SHANE CUNNINGHAM
Title or Position: OWNER
Credential:
Phone: 260-999-9115