Provider Demographics
NPI:1760100168
Name:MOBILIZED PHYSICAL THERAPY CORPORATION
Entity Type:Organization
Organization Name:MOBILIZED PHYSICAL THERAPY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:SADANG
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:510-822-8280
Mailing Address - Street 1:3732 VIRDEN AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-1537
Mailing Address - Country:US
Mailing Address - Phone:510-822-8280
Mailing Address - Fax:
Practice Address - Street 1:3732 VIRDEN AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94619-1537
Practice Address - Country:US
Practice Address - Phone:510-822-8280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty