Healthcare Provider Details

I. General information

NPI: 1083173850
Provider Name (Legal Business Name): MOBILITY THERAPY AND FITNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6959 KETCHUM DR
COLORADO SPRINGS CO
80911-9406
US

IV. Provider business mailing address

6959 KETCHUM DR
COLORADO SPRINGS CO
80911-9406
US

V. Phone/Fax

Practice location:
  • Phone: 719-229-6596
  • Fax: 719-497-6044
Mailing address:
  • Phone: 719-229-6596
  • Fax: 719-497-6044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARCUS BARNETT
Title or Position: OWNER/OPERATOR/CLINICIAN.
Credential: P.T.A.
Phone: 719-229-6596