Provider Demographics
NPI:1073067880
Name:MOBILITY PROJECT PHYSICAL THERAPY P C
Entity Type:Organization
Organization Name:MOBILITY PROJECT PHYSICAL THERAPY P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BODNER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, CLT
Authorized Official - Phone:541-255-2095
Mailing Address - Street 1:390 LINCOLN ST STE 230
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:541-255-2095
Mailing Address - Fax:541-255-2445
Practice Address - Street 1:390 LINCOLN ST STE 230
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6021
Practice Address - Country:US
Practice Address - Phone:541-255-2095
Practice Address - Fax:541-255-2445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251X0800X
OR5500261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR190987OtherMEDICARE PTAN