Provider Demographics
NPI:1871239871
Name:THE MOBILE PT, LLC
Entity type:Organization
Organization Name:THE MOBILE PT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:KERRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:940-452-2092
Mailing Address - Street 1:1217 CHESNUT MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SANTO
Mailing Address - State:TX
Mailing Address - Zip Code:76472-1410
Mailing Address - Country:US
Mailing Address - Phone:940-452-2092
Mailing Address - Fax:
Practice Address - Street 1:1217 CHESNUT MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SANTO
Practice Address - State:TX
Practice Address - Zip Code:76472-1410
Practice Address - Country:US
Practice Address - Phone:940-452-2092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-11
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy