Healthcare Provider Details

I. General information

NPI: 1598879306
Provider Name (Legal Business Name): FUNCTIONAL MOBILITY SYSTEMS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37326 COMMERCE LN
PRAIRIEVILLE LA
70769-3349
US

IV. Provider business mailing address

37326 COMMERCE LN
PRAIRIEVILLE LA
70769-3349
US

V. Phone/Fax

Practice location:
  • Phone: 225-673-2001
  • Fax: 225-673-2009
Mailing address:
  • Phone: 225-673-2001
  • Fax: 225-673-2009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number9818444-003
License Number StateLA

VIII. Authorized Official

Name: SEAN PATRICK REED
Title or Position: VP/OWNER
Credential:
Phone: 225-673-2001