Provider Demographics
NPI:1881192862
Name:ONE ON ONE MOBILITY REHAB LLC
Entity Type:Organization
Organization Name:ONE ON ONE MOBILITY REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENDELL
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:ARCENEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:770-815-8304
Mailing Address - Street 1:512 THIS WAY ST
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5128
Mailing Address - Country:US
Mailing Address - Phone:770-815-8304
Mailing Address - Fax:
Practice Address - Street 1:512 THIS WAY ST
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566
Practice Address - Country:US
Practice Address - Phone:770-815-8304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-25
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation