MEDICARE: MOBILE REHAB, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	MN-PT6097	MN

General Provider Information

NPI Number	:	1548577414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILE REHAB, LLC

Provider Business Mailing Address
First Line	:	4235 MINNESOTA LANE N
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55446
Country	:	US
Telephone Number	:	612-310-8844
Fax Number	:	763-559-1660

Provider Business Practice Location Address
First Line	:	2915 WAYZATA BLVD
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55405
Country	:	US
Telephone Number	:	612-310-8844
Fax Number	:	763-559-1660

Authorized Official
Title or Position	:	OWNER/PHYSICAL THERAPIST
Name	:	MRS. TAMMY LYNN SAPHIR
Credential	:	RPT
Telephone Number	:	612-310-8844

Provider Enumeration Date	:	09/13/2010
Last Update Date	:	09/13/2010

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