Provider Demographics
NPI:1871674473
Name:MOBILE PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:MOBILE PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:OREO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:772-871-6952
Mailing Address - Street 1:814 SW GLENVIEW CT
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2684
Mailing Address - Country:US
Mailing Address - Phone:772-871-6952
Mailing Address - Fax:772-871-6980
Practice Address - Street 1:814 SW GLENVIEW CT
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2684
Practice Address - Country:US
Practice Address - Phone:772-871-6952
Practice Address - Fax:772-871-6980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0013567225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6557Medicare ID - Type Unspecified