=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013274752
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOBILPT, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2012
-----------------------------------------------------
Last Update Date | 11/12/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17272 NEWHOPE ST STE G
-----------------------------------------------------
City | FOUNTAIN VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92708-4210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-754-7268
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 9405
-----------------------------------------------------
City | FOUNTAIN VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92728-9405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-754-7268
-----------------------------------------------------
Fax | 714-434-7042
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. JOHN HORSLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 714-754-7268
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number | 34462
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------