Healthcare Provider Details

I. General information

NPI: 1619381175
Provider Name (Legal Business Name): THERAPY MOBZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 BOARDMAN DR
GALLUP NM
87301-4801
US

IV. Provider business mailing address

106 BOARDMAN DR
GALLUP NM
87301-4801
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-9188
  • Fax: 505-926-0910
Mailing address:
  • Phone: 505-722-9188
  • Fax: 505-926-0910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number14-00002839
License Number StateNM

VIII. Authorized Official

Name: JEREMIAS TORRES II
Title or Position: CREDENTIALING
Credential: PT, DPT
Phone: 505-722-9188