Healthcare Provider Details

I. General information

NPI: 1720072580
Provider Name (Legal Business Name): MOBILE THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 02/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5126 31ST AVE S
GULFPORT FL
33707-5622
US

IV. Provider business mailing address

PO BOX 531078
SAINT PETERSBURG FL
33747-1078
US

V. Phone/Fax

Practice location:
  • Phone: 727-350-1012
  • Fax: 727-350-1012
Mailing address:
  • Phone: 727-350-1012
  • Fax: 727-350-1012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. KRISTEN M. HARRIS
Title or Position: OWNER
Credential: PT, GCS
Phone: 336-613-4111