MEDICARE: MOBILITY PROSTHETICS & ORTHOTICS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1043211378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILITY PROSTHETICS & ORTHOTICS INC

Provider Business Mailing Address
First Line	:	PO BOX 675
Second Line	:
City	:	ASHLAND
State	:	KY
Zip	:	41105-0675
Country	:	US
Telephone Number	:	606-928-1529
Fax Number	:	606-928-1549

Provider Business Practice Location Address
First Line	:	1338 CANNONSBURG RD
Second Line	:
City	:	ASHLAND
State	:	KY
Zip	:	41102-7914
Country	:	US
Telephone Number	:	606-928-1529
Fax Number	:	606-928-1549

Authorized Official
Title or Position	:	VICE PRESIDENT CO OWNER
Name	:	MR. ROBERT M LEACH
Credential	:	BOCPO CPO
Telephone Number	:	606-928-1529

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	08/22/2020

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