Healthcare Provider Details

I. General information

NPI: 1073067880
Provider Name (Legal Business Name): MOBILITY PROJECT PHYSICAL THERAPY P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 LINCOLN ST STE 230
EUGENE OR
97401-6021
US

IV. Provider business mailing address

390 LINCOLN ST STE 230
EUGENE OR
97401
US

V. Phone/Fax

Practice location:
  • Phone: 541-255-2095
  • Fax: 541-255-2445
Mailing address:
  • Phone: 541-255-2095
  • Fax: 541-255-2445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number5500
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierR190987
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerMEDICARE PTAN

VIII. Authorized Official

Name: DR. CHRISTINE M BODNER
Title or Position: PRACTICE OWNER/PHYSICAL THERAPIST
Credential: PT, DPT, CLT
Phone: 541-255-2095