Provider Demographics
NPI:1164851671
Name:TOTAL MOBILITY PT PC
Entity Type:Organization
Organization Name:TOTAL MOBILITY PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:G
Authorized Official - Last Name:JOSE-DIZON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:805-512-2359
Mailing Address - Street 1:5 EDNA DR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3717
Mailing Address - Country:US
Mailing Address - Phone:805-512-2359
Mailing Address - Fax:516-802-0216
Practice Address - Street 1:4125 KISSENA BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3150
Practice Address - Country:US
Practice Address - Phone:805-512-2359
Practice Address - Fax:516-802-0216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-05
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0287481261QP2000X
NJ40QA01330300261QP2000X
CA37085261QP2000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy