MEDICARE: BUILDING BLOCKS THERAPY 4 KIDS, 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	2251P0200X	Pediatric Physical Therapist
2	225XP0200X	Pediatric Occupational Therapist

General Provider Information

NPI Number	:	1073926051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUILDING BLOCKS THERAPY 4 KIDS, LLC

Provider Business Mailing Address
First Line	:	4334 LATHAM ST # 110
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92501-1748
Country	:	US
Telephone Number	:	909-519-8912
Fax Number	:	909-593-8988

Provider Business Practice Location Address
First Line	:	221 N SAN DIMAS AVE # 219
Second Line	:
City	:	SAN DIMAS
State	:	CA
Zip	:	91773-2664
Country	:	US
Telephone Number	:	909-519-8912
Fax Number	:	909-593-8988

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	MR. CHARLES HAWES ROBINSON IV
Credential	:
Telephone Number	:	909-519-8912

Provider Enumeration Date	:	06/06/2014
Last Update Date	:	05/23/2023

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