Healthcare Provider Details

I. General information

NPI: 1649409913
Provider Name (Legal Business Name): MOBILITY MATTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 07/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 WILSHIRE BLVD
FORT WORTH TX
76110-1717
US

IV. Provider business mailing address

2221 WILSHIRE BLVD
FORT WORTH TX
76110-1717
US

V. Phone/Fax

Practice location:
  • Phone: 817-965-3034
  • Fax:
Mailing address:
  • Phone: 817-965-3034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225CA2400X
TaxonomyAssistive Technology Practitioner Rehabilitation Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225CX0006X
TaxonomyOrientation and Mobility Training Rehabilitation Counselor
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. MICAH J MITCHELL
Title or Position: OWNER
Credential: MBA, ATP
Phone: 817-965-3034