Provider Demographics
NPI:1235258989
Name:PEDIATRIC MOBILITY, LLC
Entity Type:Organization
Organization Name:PEDIATRIC MOBILITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MAHER
Authorized Official - Suffix:
Authorized Official - Credentials:PT MSPT
Authorized Official - Phone:410-638-0973
Mailing Address - Street 1:402 POPLAR GROVE PL
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2768
Mailing Address - Country:US
Mailing Address - Phone:410-638-0973
Mailing Address - Fax:410-727-2186
Practice Address - Street 1:402 POPLAR GROVE PL
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-2768
Practice Address - Country:US
Practice Address - Phone:410-638-0973
Practice Address - Fax:410-727-2186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD200492251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD704159OtherUNITED HEALTHCARE
MD18KBOtherBLUE CROSS BLUE SHIELD
MD51490001OtherBLUE CHOICE
MD7581819OtherAETNA