Provider Demographics
NPI:1548008402
Name:CC MOBILE PHYSICAL THERAPY/WELLNESS
Entity type:Organization
Organization Name:CC MOBILE PHYSICAL THERAPY/WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:GELLERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:209-969-3858
Mailing Address - Street 1:PO BOX 270062
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78427-0062
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6022 STRASBOURG DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-6254
Practice Address - Country:US
Practice Address - Phone:361-239-2544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty