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General NPI Number Information
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NPI Number | 1609770544
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Entity Type | Organization
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Legal Business Name | MISSION MOBILE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 10/05/2026
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Last Update Date | 10/05/2026
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Provider Practice Location Address
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Address Line | 1603 LARCH ST UNIT 315
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City | LONGVIEW
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State | WA
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Zip | 98632-0801
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Country | US
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Telephone | 360-827-1651
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Fax | 888-972-6936
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Provider Business Mailing Address
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Address Line | PO BOX 315
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City | LONGVIEW
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State | WA
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Zip | 98632-7200
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Country | US
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Telephone | 360-827-1651
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Fax | 888-972-6936
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Authorized Official
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Title or Position | OWNER
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Name | ANDREW STAMP
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Credential | DPT
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Telephone | 360-827-1651
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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 | NULL
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