Provider Demographics
NPI:1164667168
Name:MOBILE THERAPY INC
Entity Type:Organization
Organization Name:MOBILE THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMIZADAY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:954-475-8445
Mailing Address - Street 1:PO BOX 451828
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33345-1828
Mailing Address - Country:US
Mailing Address - Phone:954-475-8445
Mailing Address - Fax:
Practice Address - Street 1:10741 NW 29TH CT
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33322-1017
Practice Address - Country:US
Practice Address - Phone:954-475-8445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA52668320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities