Provider Demographics
NPI:1558805390
Name:MOBILITY WORKS THERAPY SERVICES INC
Entity Type:Organization
Organization Name:MOBILITY WORKS THERAPY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TINO
Authorized Official - Middle Name:RAJU
Authorized Official - Last Name:MANIMALETHU
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:586-222-9043
Mailing Address - Street 1:49650 LAKEBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-3511
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:49650 LAKEBRIDGE DR
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315-3511
Practice Address - Country:US
Practice Address - Phone:586-222-9043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502003615261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy