Provider Demographics
NPI:1679623946
Name:MOBILITY REHABILITATION SPECIALIST
Entity type:Organization
Organization Name:MOBILITY REHABILITATION SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-232-1924
Mailing Address - Street 1:3039 PLUMBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-9662
Mailing Address - Country:US
Mailing Address - Phone:419-361-9037
Mailing Address - Fax:419-474-2505
Practice Address - Street 1:3039 PLUMBROOK DR
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-9662
Practice Address - Country:US
Practice Address - Phone:419-361-9037
Practice Address - Fax:419-474-2505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2423854Medicaid
OH2423854Medicaid