=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952777062
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOBILITY HEALTHCARE GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2015
-----------------------------------------------------
Last Update Date | 08/12/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 431 STACY RD SUITE 107
-----------------------------------------------------
City | FAIRVIEW
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75069-8741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-310-2547
-----------------------------------------------------
Fax | 214-451-6063
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5900 S LAKE FOREST DR SUITE 300
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75070-2193
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-342-8708
-----------------------------------------------------
Fax | 214-451-6063
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. ASHER KURESHY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 469-342-8708
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------