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General NPI Number Information
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NPI Number | 1962165191
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Entity Type | Organization
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Legal Business Name | MOBILITY INNOVATED, LLC
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Dates
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Enumeration Date | 10/14/2021
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Last Update Date | 10/14/2021
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Provider Practice Location Address
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Address Line | 202 N CENTRAL AVE
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City | MEDFORD
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State | OR
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Zip | 97501-5928
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Country | US
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Telephone | 541-690-8614
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Fax |
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Provider Business Mailing Address
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Address Line | 3003 CHELTENHAM WAY
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City | MEDFORD
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State | OR
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Zip | 97504-9066
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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 | PHYSICAL THERAPIST
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Name | ELLE CARLSON
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Credential | DPT
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Telephone | 541-892-4210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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