Provider Demographics
NPI:1659101814
Name:MOBILE THERAPEUTICS LLC
Entity type:Organization
Organization Name:MOBILE THERAPEUTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF ORTHOPAEDICS
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GODDEYNE
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:920-470-0333
Mailing Address - Street 1:7821 ALTMEYER DR
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-7784
Mailing Address - Country:US
Mailing Address - Phone:920-470-0333
Mailing Address - Fax:
Practice Address - Street 1:7821 ALTMEYER DR
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-7784
Practice Address - Country:US
Practice Address - Phone:920-470-0333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-02
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty