Provider Demographics
NPI:1205604576
Name:MOBLEY, JUSTIN THOMAS
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:THOMAS
Last Name:MOBLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 E ORCHARD ST APT 17
Mailing Address - Street 2:
Mailing Address - City:PAYNE
Mailing Address - State:OH
Mailing Address - Zip Code:45880-9498
Mailing Address - Country:US
Mailing Address - Phone:419-670-5645
Mailing Address - Fax:
Practice Address - Street 1:8316 ROAD 71
Practice Address - Street 2:
Practice Address - City:PAULDING
Practice Address - State:OH
Practice Address - Zip Code:45879-9102
Practice Address - Country:US
Practice Address - Phone:419-796-1369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker