Provider Demographics
NPI:1205004165
Name:MOBLEY, BRITNEY LEIGH (PT)
Entity type:Individual
Prefix:
First Name:BRITNEY
Middle Name:LEIGH
Last Name:MOBLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BRITNEY
Other - Middle Name:LEIGH
Other - Last Name:WETHERINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:8259 WICKER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-8878
Mailing Address - Country:US
Mailing Address - Phone:219-365-6560
Mailing Address - Fax:
Practice Address - Street 1:27 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-4757
Practice Address - Country:US
Practice Address - Phone:229-616-9921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009266225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4050Medicare PIN