Provider Demographics
NPI:1023017472
Name:MOBILE PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:MOBILE PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT MS OCS
Authorized Official - Phone:804-726-2340
Mailing Address - Street 1:3604 MILBRANCH PL
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-7634
Mailing Address - Country:US
Mailing Address - Phone:804-726-2340
Mailing Address - Fax:804-726-2341
Practice Address - Street 1:3604 MILBRANCH PL
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-7634
Practice Address - Country:US
Practice Address - Phone:804-726-2340
Practice Address - Fax:804-726-2341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202101225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
105429OtherANTHEM BCBS
105429OtherANTHEM BCBS
C09058Medicare ID - Type UnspecifiedGROUP #