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General NPI Number Information
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NPI Number | 1063008639
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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 | 12/17/2020
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Last Update Date | 12/17/2020
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Provider Practice Location Address
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Address Line | 1231 N JOHNSTON AVE
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City | ROCKFORD
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State | IL
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Zip | 61101-2544
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Country | US
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Telephone | 773-746-3660
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Fax | 773-326-3604
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Provider Business Mailing Address
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Address Line | 1231 N JOHNSTON AVE
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City | ROCKFORD
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State | IL
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Zip | 61101-2544
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Country | US
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Telephone | 773-746-3660
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF PHYSICAL THERAPY
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Name | RASHAWN WHITE
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Credential | DPT
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Telephone | 773-746-3660
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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 |
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License Number State |
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