Healthcare Provider Details

I. General information

NPI: 1952308207
Provider Name (Legal Business Name): MOBILITY PRODUCTS DEPOT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 LAFAYETTE STREET
YOUNGSVILLE LA
70592
US

IV. Provider business mailing address

PO BOX 840
YOUNGSVILLE LA
70592-0840
US

V. Phone/Fax

Practice location:
  • Phone: 337-504-2743
  • Fax: 337-504-3014
Mailing address:
  • Phone: 337-504-2743
  • Fax: 337-504-3014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. CHARLES W. LANDRY
Title or Position: OWNER
Credential:
Phone: 337-504-2743