Healthcare Provider Details

I. General information

NPI: 1215547872
Provider Name (Legal Business Name): MOBILE HEALTH PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4535 N HABITAT WAY
APPLETON WI
54913-6727
US

IV. Provider business mailing address

4535 N HABITAT WAY
APPLETON WI
54913-6727
US

V. Phone/Fax

Practice location:
  • Phone: 920-997-8002
  • Fax:
Mailing address:
  • Phone: 920-997-8002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL ZIELINSKI
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT
Phone: 920-277-7175