Provider Demographics
NPI:1518647981
Name:MOBILE PHYSICAL THERAPY PROS LLC
Entity Type:Organization
Organization Name:MOBILE PHYSICAL THERAPY PROS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:REUSCHLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:470-280-9092
Mailing Address - Street 1:2352 VALLEY MILL CT
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-2261
Mailing Address - Country:US
Mailing Address - Phone:770-324-3726
Mailing Address - Fax:
Practice Address - Street 1:4260 CREEK PARK DR STE A
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-3988
Practice Address - Country:US
Practice Address - Phone:470-280-9092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty