Provider Demographics
NPI:1629685029
Name:MOBILE REHAB GROUP LLC
Entity Type:Organization
Organization Name:MOBILE REHAB GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:986-224-8424
Mailing Address - Street 1:516 S WOODDALE PL
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-7713
Mailing Address - Country:US
Mailing Address - Phone:986-224-8424
Mailing Address - Fax:208-504-2821
Practice Address - Street 1:516 S WOODDALE PL
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-7713
Practice Address - Country:US
Practice Address - Phone:986-224-8424
Practice Address - Fax:208-504-2821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty