MEDICARE: MOBILITY PROSTHETIC AND ORTHOTIC SERVICES LLC

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	:	1508528654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILITY PROSTHETIC AND ORTHOTIC SERVICES LLC

Provider Business Mailing Address
First Line	:	1675 MESQUITE AVE STE A
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5665
Country	:	US
Telephone Number	:	928-680-4089
Fax Number	:	928-680-0089

Provider Business Practice Location Address
First Line	:	1675 MESQUITE AVE STE A
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5665
Country	:	US
Telephone Number	:	928-680-4089
Fax Number	:	928-680-0089

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	RAJIV ROY
Credential	:
Telephone Number	:	714-390-7533

Provider Enumeration Date	:	10/06/2021
Last Update Date	:	08/07/2025

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