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General NPI Number Information
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NPI Number | 1497453427
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Entity Type | Organization
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Legal Business Name | MOBILITYWISE LLC
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Dates
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Enumeration Date | 02/20/2023
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Last Update Date | 01/05/2024
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Provider Practice Location Address
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Address Line | 19349 HIGHLAND DR
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City | NEW BUFFALO
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State | MI
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Zip | 49117-8942
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Country | US
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Telephone | 773-823-6306
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Fax |
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Provider Business Mailing Address
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Address Line | 19349 HIGHLAND DR
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City | NEW BUFFALO
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State | MI
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Zip | 49117-8942
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Country | US
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Telephone | 773-824-6306
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Fax |
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Authorized Official
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Title or Position | PT
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Name | REBECCA LYNN GARDNER-REILLY
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Credential | PT
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Telephone | 773-824-6306
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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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