Healthcare Provider Details

I. General information

NPI: 1609770544
Provider Name (Legal Business Name): MISSION MOBILE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 LARCH ST UNIT 315
LONGVIEW WA
98632-0801
US

IV. Provider business mailing address

PO BOX 315
LONGVIEW WA
98632-7200
US

V. Phone/Fax

Practice location:
  • Phone: 360-827-1651
  • Fax: 888-972-6936
Mailing address:
  • Phone: 360-827-1651
  • Fax: 888-972-6936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANDREW STAMP
Title or Position: OWNER
Credential: DPT
Phone: 360-827-1651