Provider Demographics
NPI:1366080467
Name:MOBILITY SPA LLC
Entity type:Organization
Organization Name:MOBILITY SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER/LMT
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:LUIZA
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:703-965-6802
Mailing Address - Street 1:2 CANTERBURY SQ APT 302
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-3049
Mailing Address - Country:US
Mailing Address - Phone:703-965-6802
Mailing Address - Fax:
Practice Address - Street 1:2300 N PERSHING DR STE 201
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-1428
Practice Address - Country:US
Practice Address - Phone:703-646-8848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty