MEDICARE: BUBBLES BUBBLES BUBBLES,LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305S00000X	Point of Service

General Provider Information

NPI Number	:	1457699829
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUBBLES BUBBLES BUBBLES,LLC

Provider Business Mailing Address
First Line	:	1535 ELLSWORTH ST
Second Line	:	SUITE A
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-3109
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1535 ELLSWORTH ST
Second Line	:	SUITE A
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-3109
Country	:	US
Telephone Number	:	443-993-9741
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	MS. CRYSTAL EVANS
Credential	:
Telephone Number	:	443-993-9741

Provider Enumeration Date	:	01/20/2013
Last Update Date	:	01/20/2013

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