Healthcare Provider Details

I. General information

NPI: 1124966577
Provider Name (Legal Business Name): MOBILITY PROSTHETICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 S STATE ST STE 100
OREM UT
84097-8143
US

IV. Provider business mailing address

1815 S STATE ST STE 100
OREM UT
84097-8143
US

V. Phone/Fax

Practice location:
  • Phone: 801-436-8847
  • Fax: 801-436-8847
Mailing address:
  • Phone: 801-436-8847
  • Fax: 801-436-8847

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: JAKE MARTIN
Title or Position: OFFICE MANAGER
Credential:
Phone: 801-436-8847