Healthcare Provider Details

I. General information

NPI: 1336072149
Provider Name (Legal Business Name): MOBILE MOTION REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 BLOOMFIELD AVE APT 404
BLOOMFIELD NJ
07003-5761
US

IV. Provider business mailing address

206 BLOOMFIELD AVE APT 404
BLOOMFIELD NJ
07003-5761
US

V. Phone/Fax

Practice location:
  • Phone: 201-889-0314
  • Fax:
Mailing address:
  • Phone: 201-889-0314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. CALLIE EVANCHICK
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 201-889-0314