Provider Demographics
NPI:1053452714
Name:MOBILE PHYSICAL THERAPY
Entity type:Organization
Organization Name:MOBILE PHYSICAL THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-573-8204
Mailing Address - Street 1:1301 PALUXY RD
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-5663
Mailing Address - Country:US
Mailing Address - Phone:817-573-8204
Mailing Address - Fax:817-573-8472
Practice Address - Street 1:1301 PALUXY RD
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-5663
Practice Address - Country:US
Practice Address - Phone:817-573-8204
Practice Address - Fax:817-573-8472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX627890000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7047011OtherAETNA
TX83294TOtherBLUE CROSS BLUE SHIELD
TX83294TOtherBLUE CROSS BLUE SHIELD