Provider Demographics
NPI:1164627758
Name:MOBBS, KEVIN MICHAEL (PT, DPT, DN)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:MICHAEL
Last Name:MOBBS
Suffix:
Gender:M
Credentials:PT, DPT, DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 MILES ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30601-1820
Mailing Address - Country:US
Mailing Address - Phone:706-546-1333
Mailing Address - Fax:706-546-5807
Practice Address - Street 1:195 MILES ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-1820
Practice Address - Country:US
Practice Address - Phone:706-546-1333
Practice Address - Fax:706-546-5807
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT9055225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA116807Medicare ID - Type UnspecifiedGROUP #