Provider Demographics
NPI:1629308127
Name:MOBILE THERAPEUTIC SERVICES, LLC
Entity Type:Organization
Organization Name:MOBILE THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TAMERA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:901-292-3294
Mailing Address - Street 1:5558 LIBERTY RIDGE CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-4262
Mailing Address - Country:US
Mailing Address - Phone:901-292-3294
Mailing Address - Fax:901-756-6838
Practice Address - Street 1:5558 LIBERTY RIDGE CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-4262
Practice Address - Country:US
Practice Address - Phone:901-292-3294
Practice Address - Fax:901-756-6838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5975261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy