Provider Demographics
NPI:1598034597
Name:MOBILITY WORKS THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:MOBILITY WORKS THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-512-3125
Mailing Address - Street 1:1258 FORK RETCH CT
Mailing Address - Street 2:
Mailing Address - City:MULLINS
Mailing Address - State:SC
Mailing Address - Zip Code:29574-5959
Mailing Address - Country:US
Mailing Address - Phone:631-512-3125
Mailing Address - Fax:843-353-0167
Practice Address - Street 1:1258 FORK RETCH CT
Practice Address - Street 2:
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574-5959
Practice Address - Country:US
Practice Address - Phone:631-512-3125
Practice Address - Fax:843-353-0167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6280225100000X
SC4366225100000X
SC1780225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty