=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538580204
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BMJ THERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2013
-----------------------------------------------------
Last Update Date | 12/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 999 TRAIL TERRACE DR
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34103-2329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-649-2222
-----------------------------------------------------
Fax | 239-649-0522
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 510 W MAIN ST SUITE B
-----------------------------------------------------
City | CANFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44406-1454
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-702-0110
-----------------------------------------------------
Fax | 330-286-0434
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/PRESIDENT
-----------------------------------------------------
Name | RENEE HALFHILL
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 330-702-0110
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------