Basic Information
| Provider Information | |||||||||
| NPI: | 1073067880 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOBILITY PROJECT PHYSICAL THERAPY P C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 390 LINCOLN ST STE 230 | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412552095 | ||||||||
| FaxNumber: | 5412552445 | ||||||||
| Practice Location | |||||||||
| Address1: | 390 LINCOLN ST STE 230 | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974016021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412552095 | ||||||||
| FaxNumber: | 5412552445 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2016 | ||||||||
| LastUpdateDate: | 07/03/2019 | ||||||||
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| AuthorizedOfficialLastName: | BODNER | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE OWNER/PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 5412552095 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PT, DPT, CLT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 5500 | OR | N | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | 2251X0800X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
ID Information
| ID | Type | State | Issuer | Description | R190987 | 01 | OR | MEDICARE PTAN | OTHER |