Healthcare Provider Details

I. General information

NPI: 1568421881
Provider Name (Legal Business Name): MOBILITY PROSTHETICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 10/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 WOODRUFF ROAD
GREENVILLE SC
29607
US

IV. Provider business mailing address

2007 WOODRUFF ROAD
GREENVILLE SC
29607
US

V. Phone/Fax

Practice location:
  • Phone: 864-281-9399
  • Fax: 864-281-9396
Mailing address:
  • Phone: 864-281-9399
  • Fax: 864-281-9396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: JEFFERY LEN SANDERS
Title or Position: OWNER
Credential: CPO
Phone: 864-281-9399