Provider Demographics
NPI:1891442265
Name:FUNCTIONAL MOBILITY SERVICES LLC
Entity Type:Organization
Organization Name:FUNCTIONAL MOBILITY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PTA
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:PTA ASS
Authorized Official - Phone:770-853-9298
Mailing Address - Street 1:4186 DUESENBERG DR
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-7531
Mailing Address - Country:US
Mailing Address - Phone:770-853-9298
Mailing Address - Fax:
Practice Address - Street 1:4186 DUESENBERG DR
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-7531
Practice Address - Country:US
Practice Address - Phone:770-853-9298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-07
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty