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General NPI Number Information
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NPI Number | 1831820422
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Entity Type | Organization
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Legal Business Name | MOBILE WATER THERAPY
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Dates
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Enumeration Date | 06/23/2022
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Last Update Date | 06/23/2022
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Provider Practice Location Address
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Address Line | 37903 EUCLID AVE
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City | WILLOUGHBY
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State | OH
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Zip | 44094-5978
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Country | US
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Telephone | 216-406-1195
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1502
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City | WILLOUGHBY
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State | OH
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Zip | 44096-1502
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Country | US
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Telephone | 216-406-1195
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LOLITA RICHMOND
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Credential |
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Telephone | 928-374-2722
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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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Taxonomy #2
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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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