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General NPI Number Information
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NPI Number | 1184956682
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Entity Type | Organization
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Legal Business Name | THE MOBILITY STORE LLC
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Dates
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Enumeration Date | 02/08/2010
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Last Update Date | 03/24/2016
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Provider Practice Location Address
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Address Line | 915 N FLORIDA AVE
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City | LAKELAND
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State | FL
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Zip | 33801-1707
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Country | US
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Telephone | 863-688-3900
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Fax | 863-688-3991
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Provider Business Mailing Address
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Address Line | 915 N FLORIDA AVE
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City | LAKELAND
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State | FL
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Zip | 33801-1707
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Country | US
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Telephone | 863-688-3900
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Fax | 863-688-3991
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Authorized Official
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Title or Position | OWNER
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Name | MS. RENEE NAKHOUL
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Credential |
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Telephone | 863-688-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 1313617
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License Number State | FL
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