Provider Demographics
NPI:1619381175
Name:THERAPY MOBZ LLC
Entity Type:Organization
Organization Name:THERAPY MOBZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JEREMIAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:II
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:505-722-9188
Mailing Address - Street 1:106 BOARDMAN DR
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-4801
Mailing Address - Country:US
Mailing Address - Phone:505-722-9188
Mailing Address - Fax:505-926-0910
Practice Address - Street 1:106 BOARDMAN DR
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-4801
Practice Address - Country:US
Practice Address - Phone:505-722-9188
Practice Address - Fax:505-926-0910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-12
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM14-00002839261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy