Provider Demographics
NPI:1215347448
Name:MOBILE THERAPY
Entity type:Organization
Organization Name:MOBILE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:843-906-1400
Mailing Address - Street 1:3034 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:BAMBERG
Mailing Address - State:SC
Mailing Address - Zip Code:29003-1786
Mailing Address - Country:US
Mailing Address - Phone:843-906-1400
Mailing Address - Fax:
Practice Address - Street 1:3034 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:BAMBERG
Practice Address - State:SC
Practice Address - Zip Code:29003-1786
Practice Address - Country:US
Practice Address - Phone:843-906-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3580261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy