Healthcare Provider Details

I. General information

NPI: 1063322253
Provider Name (Legal Business Name): MAVERICK MOBILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 KERMIT DR
KNOXVILLE TN
37912-3861
US

IV. Provider business mailing address

100 PACIFIC RD
OAK RIDGE TN
37830-5102
US

V. Phone/Fax

Practice location:
  • Phone: 865-719-3966
  • Fax:
Mailing address:
  • Phone: 865-719-3966
  • Fax:

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: PETER CAPELL
Title or Position: OWNER
Credential: ATP
Phone: 865-719-3966