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General NPI Number Information
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NPI Number | 1053452714
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Entity Type | Organization
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Legal Business Name | MOBILE PHYSICAL THERAPY
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 09/02/2010
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Provider Practice Location Address
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Address Line | 1301 PALUXY RD
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City | GRANBURY
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State | TX
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Zip | 76048-5663
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Country | US
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Telephone | 817-573-8204
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Fax | 817-573-8472
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Provider Business Mailing Address
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Address Line | 1301 PALUXY RD
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City | GRANBURY
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State | TX
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Zip | 76048-5663
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Country | US
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Telephone | 817-573-8204
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Fax | 817-573-8472
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JULIE ANN TOUT
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Credential |
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Telephone | 817-573-8204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 627890000
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License Number State | TX
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