MEDICARE: CARRY ON THERAPY 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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1508548256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARRY ON THERAPY LLC

Provider Business Mailing Address
First Line	:	2502 MOUNT MORIAH RD STE H231
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38115-1515
Country	:	US
Telephone Number	:	718-473-5409
Fax Number	:

Provider Business Practice Location Address
First Line	:	2502 MOUNT MORIAH RD STE H231
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38115-1515
Country	:	US
Telephone Number	:	718-473-5409
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MORDECHAI DEMBITZER
Credential	:
Telephone Number	:	718-473-5409

Provider Enumeration Date	:	08/02/2023
Last Update Date	:	08/02/2023

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Directions to “CARRY ON THERAPY LLC ” Practice Location

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