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General NPI Number Information
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NPI Number | 1568602175
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Entity Type | Organization
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Legal Business Name | MCB THERAPY SERVICES,INC.
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Dates
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Enumeration Date | 02/23/2009
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Last Update Date | 02/23/2009
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Provider Practice Location Address
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Address Line | 341 S WOODFIELD LN
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City | BLOOMINGTON
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State | IN
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Zip | 47403-9070
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Country | US
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Telephone | 812-361-1648
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Fax | 812-825-8815
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Provider Business Mailing Address
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Address Line | 341 S WOODFIELD LN
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City | BLOOMINGTON
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State | IN
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Zip | 47403-9070
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Country | US
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Telephone | 812-361-1648
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Fax | 812-825-8815
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Authorized Official
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Title or Position | CEO
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Name | MRS. MARIA CIELITO BERIN
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Credential | PT
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Telephone | 812-361-1648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 05006267A
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License Number State | IN
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