=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205467313
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A TO Z REPAIR & MOBILITY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2020
-----------------------------------------------------
Last Update Date | 01/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1619 3RD AVE SE
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55904-7945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-258-6277
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1619 3RD AVE SE
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55904-7945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-258-6277
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TRACY JOHN SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 507-440-1915
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171WV0202X
-----------------------------------------------------
Taxonomy Name | Vehicle Modifications Contractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------