Healthcare Provider Details

I. General information

NPI: 1356971154
Provider Name (Legal Business Name): MOBILITY FIT PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2020
Last Update Date: 01/21/2020
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11125 KENWOOD RD.
BLUE ASH OH
45242-4545
US

IV. Provider business mailing address

715 CONGRESS PARK DR
CENTERVILLE OH
45459-4044
US

V. Phone/Fax

Practice location:
  • Phone: 513-802-1929
  • Fax: 888-972-7349
Mailing address:
  • Phone: 513-802-1929
  • Fax: 888-972-7349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANDREW SAMUEL COOK
Title or Position: OWNER
Credential:
Phone: 303-710-0515