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General NPI Number Information
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NPI Number | 1780571596
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Entity Type | Organization
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Legal Business Name | MOBILITY BOOSTERS PLLC
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Dates
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Enumeration Date | 06/23/2025
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 6631 N MILWAUKEE AVE
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City | NILES
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State | IL
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Zip | 60714-4416
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Country | US
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Telephone | 732-533-8056
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Fax |
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Provider Business Mailing Address
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Address Line | 727 W MADISON ST APT 1403
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City | CHICAGO
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State | IL
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Zip | 60661-2409
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRANDON FORMAN
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Credential |
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Telephone | 732-533-8056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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