Healthcare Provider Details

I. General information

NPI: 1528168077
Provider Name (Legal Business Name): ENDLESS MOUNTAINS BRACE AND MOBILITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6819 FALL BROOK RD
TROY PA
16947-1604
US

IV. Provider business mailing address

6819 FALL BROOK RD
TROY PA
16947-1604
US

V. Phone/Fax

Practice location:
  • Phone: 570-297-2993
  • Fax:
Mailing address:
  • Phone: 570-297-2993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. JENNIFER A. FERGUSON
Title or Position: CEO
Credential:
Phone: 570-297-2993