Provider Demographics
NPI:1194873935
Name:UNLIMITED MOBILITY THERAPY, INC
Entity type:Organization
Organization Name:UNLIMITED MOBILITY THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:BRIM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:708-799-5569
Mailing Address - Street 1:18428 GOVERNORS HWY
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2911
Mailing Address - Country:US
Mailing Address - Phone:708-799-5569
Mailing Address - Fax:708-799-5618
Practice Address - Street 1:18430 GOVERNORS HWY
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2911
Practice Address - Country:US
Practice Address - Phone:708-799-5569
Practice Address - Fax:708-799-5618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL346802184001Medicaid
IL01635359OtherBLUE SHIELD PROVIDER #