Provider Demographics
NPI:1780921122
Name:MOBLEY, LARRY JAMES (PTA)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:JAMES
Last Name:MOBLEY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 SUNSET TER
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-6417
Mailing Address - Country:US
Mailing Address - Phone:806-433-1468
Mailing Address - Fax:
Practice Address - Street 1:413 SUNSET TER
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-6417
Practice Address - Country:US
Practice Address - Phone:806-433-1468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2047504225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant