Provider Demographics
NPI:1437217296
Name:MOBILITY REHAB PLLC
Entity Type:Organization
Organization Name:MOBILITY REHAB PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:269-288-0257
Mailing Address - Street 1:PO BOX 2188
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49016-2188
Mailing Address - Country:US
Mailing Address - Phone:269-288-0257
Mailing Address - Fax:269-962-0439
Practice Address - Street 1:229 NORTH AVENUE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017
Practice Address - Country:US
Practice Address - Phone:269-288-0257
Practice Address - Fax:269-962-0439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007813225100000X
MI5501007682225100000X
MI5201002348225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0007890689OtherAETNA
MI35525OtherHEALTH PLAN OF MICHIGAN
MI35525OtherHEALTH PLAN OF MICHIGAN
MI0N90030Medicare ID - Type UnspecifiedMEDICARE