MEDICARE: MOBILIZE PHYSICAL THERAPY

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
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1619527694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILIZE PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	1000 CRYSTAL WAY APT O
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33444-1059
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 CRYSTAL WAY APT O
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33444-1059
Country	:	US
Telephone Number	:	229-881-2594
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WILLIAM BUCHANAN
Credential	:	DPT
Telephone Number	:	229-881-2594

Provider Enumeration Date	:	09/12/2019
Last Update Date	:	09/12/2019

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Directions to “MOBILIZE PHYSICAL THERAPY ” Practice Location

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