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NPI Code Detail

MEDICARE: MOBILE THERAPY CENTER OF AMERICA, LLC

MEDICARE: MOBILE THERAPY CENTER OF AMERICA, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker
2225100000XPhysical Therapist
3225X00000XOccupational Therapist
4235Z00000XSpeech-Language Pathologist
5261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1225064488
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOBILE THERAPY CENTER OF AMERICA, LLC
Provider Business Mailing Address
First Line : 854 TECHNOLOGY WAY
Second Line :
City : LIBERTYVILLE
State : IL
Zip : 60048-5350
Country : US
Telephone Number : 847-816-7200
Fax Number : 847-816-7210
Provider Business Practice Location Address
First Line : 854 TECHNOLOGY WAY
Second Line :
City : LIBERTYVILLE
State : IL
Zip : 60048-5350
Country : US
Telephone Number : 847-816-7200
Fax Number : 847-816-7210
Authorized Official
Title or Position : OWNER
Name : JASON NEWMAN
Credential :
Telephone Number : 224-354-1290
Provider Enumeration Date : 06/22/2006
Last Update Date : 12/27/2023

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Directions to “MOBILE THERAPY CENTER OF AMERICA, LLC ” Practice Location

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