Provider Demographics
NPI:1063008639
Name:MOBILE PHYSICAL THERAPY
Entity type:Organization
Organization Name:MOBILE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:RASHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:773-746-3660
Mailing Address - Street 1:1231 N JOHNSTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61101-2544
Mailing Address - Country:US
Mailing Address - Phone:773-746-3660
Mailing Address - Fax:
Practice Address - Street 1:1231 N JOHNSTON AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61101-2544
Practice Address - Country:US
Practice Address - Phone:773-746-3660
Practice Address - Fax:773-326-3604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty