Provider Demographics
NPI:1124378906
Name:MTM ON THE GO
Entity Type:Organization
Organization Name:MTM ON THE GO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DESHAWNDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:407-271-5493
Mailing Address - Street 1:3022 SEABROOK AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-6007
Mailing Address - Country:US
Mailing Address - Phone:407-271-5493
Mailing Address - Fax:
Practice Address - Street 1:3022 SEABROOK AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-6007
Practice Address - Country:US
Practice Address - Phone:407-271-5493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care