=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053483412
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOBILE THERAPY SOLUTIONS, P.L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12205 ROHAN RD
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73170-4747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-641-2571
-----------------------------------------------------
Fax | 405-691-2227
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 891197
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73189-1197
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-641-2571
-----------------------------------------------------
Fax | 405-691-2227
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. LEAH MARIE FITZPATRICK
-----------------------------------------------------
Credential | PHYSICAL THERAPIST
-----------------------------------------------------
Telephone | 405-641-2571
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT2102
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------