=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073313110
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARRY-ON MOBILE PHYSICAL THERAPY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2025
-----------------------------------------------------
Last Update Date | 04/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15606 HIGH BELL PL
-----------------------------------------------------
City | BRADENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34212-3911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-774-8429
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15606 HIGH BELL PL
-----------------------------------------------------
City | BRADENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34212-3911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-774-8429
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF PHYSICAL THERAPY
-----------------------------------------------------
Name | LUTHGARDA BRUBAKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 850-774-8429
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------