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General NPI Number Information
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NPI Number | 1710163951
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Entity Type | Organization
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Legal Business Name | MOBLEY PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 01/17/2008
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Last Update Date | 09/29/2010
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Provider Practice Location Address
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Address Line | 151 E MAIN ST
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City | RIGBY
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State | ID
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Zip | 83442-1417
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Country | US
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Telephone | 208-745-8332
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Fax | 208-745-8272
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Provider Business Mailing Address
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Address Line | 151 E MAIN ST
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City | RIGBY
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State | ID
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Zip | 83442-1417
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Country | US
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Telephone | 208-745-8332
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Fax | 208-745-8272
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | TRACY ERROL MOBLEY
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Credential | MSPT
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Telephone | 208-745-8332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | RPT895
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License Number State | ID
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