Healthcare Provider Details

I. General information

NPI: 1295200558
Provider Name (Legal Business Name): MOBILITY PROSTHETICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2018
Last Update Date: 10/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 E WINCHESTER ST STE 275
MURRAY UT
84107-7588
US

IV. Provider business mailing address

480 E WINCHESTER ST STE 275
MURRAY UT
84107-7588
US

V. Phone/Fax

Practice location:
  • Phone: 801-997-1367
  • Fax: 801-997-1367
Mailing address:
  • Phone: 801-997-1367
  • Fax: 801-997-1367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name: BRIAN J GREER
Title or Position: OWNER
Credential: CP, BOCO
Phone: 801-997-1367