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General NPI Number Information
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NPI Number | 1225847833
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Entity Type | Organization
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Legal Business Name | CREST CUSTOM MOBILITY LLC
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 505 MOUNTAIN DR STE I
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City | DESTIN
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State | FL
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Zip | 32541-7334
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Country | US
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Telephone | 321-360-6016
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Fax |
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Provider Business Mailing Address
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Address Line | 4533 LEILANI LN
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-8500
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Country | US
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Telephone | 321-360-6016
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LINDSAY SEGO
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Credential |
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Telephone | 321-360-6016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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