=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851089205
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BARNABUS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2023
-----------------------------------------------------
Last Update Date | 04/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10806 REISTERSTOWN RD STE 3C
-----------------------------------------------------
City | OWINGS MILLS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21117-2791
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-850-1005
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10806 REISTERSTOWN RD STE 3C
-----------------------------------------------------
City | OWINGS MILLS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21117-2791
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-850-1005
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. CLEDITH ALFONZO LEE JR.
-----------------------------------------------------
Credential | PHYSICAL THERAPY
-----------------------------------------------------
Telephone | 443-850-1005
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------