=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104553585
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH ALLEN MOHLER PT, DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2022
-----------------------------------------------------
Last Update Date | 11/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4543 WESTON RD
-----------------------------------------------------
City | WESTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33331-3140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-233-0745
-----------------------------------------------------
Fax | 954-231-2576
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5347 NW 126TH DR
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33076-3405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-444-4460
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT39116
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------