Provider Demographics
NPI:1437976164
Name:MOBILITY VITALITY AND PERFORMANCE PHYSICAL THERAPY AND WELLNESS
Entity type:Organization
Organization Name:MOBILITY VITALITY AND PERFORMANCE PHYSICAL THERAPY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:
Authorized Official - Last Name:FULSE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:863-529-3989
Mailing Address - Street 1:3415 MORAN RD.
Mailing Address - Street 2:
Mailing Address - City:TAMPA, FLORIDA, UNITED STATES
Mailing Address - State:FL
Mailing Address - Zip Code:33618
Mailing Address - Country:US
Mailing Address - Phone:863-529-3989
Mailing Address - Fax:
Practice Address - Street 1:3415 MORAN RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2558
Practice Address - Country:US
Practice Address - Phone:863-529-3989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty