MEDICARE: MOBILE DIAGNOSTIC SOLUTIONS 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
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1699094490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILE DIAGNOSTIC SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	907 OUTER RD
Second Line	:	SUITE B
City	:	ORLANDO
State	:	FL
Zip	:	32814-6601
Country	:	US
Telephone Number	:	407-574-2127
Fax Number	:	407-574-5628

Provider Business Practice Location Address
First Line	:	907 OUTER RD
Second Line	:	SUITE B
City	:	ORLANDO
State	:	FL
Zip	:	32814-6601
Country	:	US
Telephone Number	:	407-574-2127
Fax Number	:	407-574-5628

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MORGAN KANE
Credential	:
Telephone Number	:	407-694-2813

Provider Enumeration Date	:	05/19/2010
Last Update Date	:	08/31/2010

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