Provider Demographics
NPI:1720072580
Name:MOBILE THERAPY, INC
Entity Type:Organization
Organization Name:MOBILE THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, GCS
Authorized Official - Phone:336-613-4111
Mailing Address - Street 1:PO BOX 531078
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33747-1078
Mailing Address - Country:US
Mailing Address - Phone:727-350-1012
Mailing Address - Fax:727-350-1012
Practice Address - Street 1:5126 31ST AVE S
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:FL
Practice Address - Zip Code:33707-5622
Practice Address - Country:US
Practice Address - Phone:727-350-1012
Practice Address - Fax:727-350-1012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2016-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2331515Medicare ID - Type Unspecified
FLIF826AMedicare PIN