Provider Demographics
NPI:1275274896
Name:FULL RANGE MOBILE PT, LLC
Entity Type:Organization
Organization Name:FULL RANGE MOBILE PT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BECHTOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:913-526-4434
Mailing Address - Street 1:608 N WINNEBAGO DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WINNEBAGO
Mailing Address - State:MO
Mailing Address - Zip Code:64034-9419
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:608 N WINNEBAGO DR
Practice Address - Street 2:
Practice Address - City:LAKE WINNEBAGO
Practice Address - State:MO
Practice Address - Zip Code:64034-9419
Practice Address - Country:US
Practice Address - Phone:913-526-4434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty