Provider Demographics
NPI:1649890617
Name:MOBILE THERAPY SERVICES
Entity type:Organization
Organization Name:MOBILE THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:EASTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:405-513-2212
Mailing Address - Street 1:2117 CEDAR POINTE LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-2463
Mailing Address - Country:US
Mailing Address - Phone:405-513-2212
Mailing Address - Fax:
Practice Address - Street 1:2117 CEDAR POINTE LN
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-2463
Practice Address - Country:US
Practice Address - Phone:405-513-2212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2407OtherSTATE LICENSE