Mobile Spine Specialist LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

MOBILE SPINE SPECIALIST LLC

Doing business as

Mobile Spine Specialist

Practice address

601 Quail Valley Dr
Georgetown, TX 78626-8051

Phone

(512) 559-6551

Fax

(512) 591-0789

NPI assigned

Mar 1, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jeffrey Lum, PT, MPT, DIP. MDT

Title

Physical Therapist/Owner

Phone

(512) 559-6551

Specialties & licenses 1

Addresses

Other names 1

• Mobile Spine Specialist Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1583020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605830400000",
    "number": "1033743968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 QUAIL VALLEY DR",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786268051",
            "telephone_number": "512-559-6551",
            "fax_number": "512-591-0789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 QUAIL VALLEY DR",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786268051",
            "telephone_number": "512-559-6551",
            "fax_number": "512-591-0789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILE SPINE SPECIALIST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-01",
        "last_updated": "2020-11-20",
        "certification_date": "2020-11-20",
        "status": "A",
        "authorized_official_last_name": "LUM",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST/OWNER",
        "authorized_official_telephone_number": "512-559-6551",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT, MPT, DIP. MDT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mobile Spine Specialist",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mobile Spine Specialist",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dewayne Mark Mirtsching, DC
• Harriet Mitchell
• Jacqueline Mitchell
• Megan Mitchell
• Mobile CR Imaging, LLC
• Heather Moeller
• Marlene Mogavero, RDMS, RVT
• Zia Mohammad, RPH
• Arvind Chintagumpala Mohan, MD, MBA
• Syed Haris Mohiuddin, D.P.M

• Physical Therapy Clinic/Center in Georgetown, TX
• Providers in Georgetown, TX by specialty
• Physical Therapy Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.