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General NPI Number Information
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NPI Number | 1770110801
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Entity Type | Organization
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Legal Business Name | MOBILE PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 03/26/2020
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Last Update Date | 05/11/2022
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Provider Practice Location Address
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Address Line | 112 N ELDEN ST
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-5295
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Country | US
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Telephone | 928-421-3581
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 30212
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City | FLAGSTAFF
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State | AZ
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Zip | 86003-0212
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Country | US
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Telephone | 928-421-3581
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Fax |
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Authorized Official
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Title or Position | OWNER, PHYSICAL THERAPIST
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Name | JAMIE ORNELAS
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Credential | DPT
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Telephone | 928-421-3581
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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 |
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License Number State |
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