1043211378 NPI number — MOBILITY PROSTHETICS & ORTHOTICS INC

Table of content: BROOKS PARKER DPT, CDN (NPI 1104489095)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043211378 NPI number — MOBILITY PROSTHETICS & ORTHOTICS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOBILITY PROSTHETICS & ORTHOTICS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043211378
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1338 CANNONSBURG RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41102-7914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-928-1529
Provider Business Practice Location Address Fax Number:
606-928-1549
Provider Enumeration Date:
08/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LEACH
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
M
Authorized Official Title or Position:
VICE PRESIDENT CO OWNER
Authorized Official Telephone Number:
606-928-1529

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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