MEDICARE: BIOENERGETICS MIND BODY MEDICINE

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	261QH0100X	Health Service Clinic/Center	AP2956	FL

General Provider Information

NPI Number	:	1538443825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIOENERGETICS MIND BODY MEDICINE

Provider Business Mailing Address
First Line	:	2314 W PRICE BLVD
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34286
Country	:	US
Telephone Number	:	941-769-2474
Fax Number	:

Provider Business Practice Location Address
First Line	:	2314 W PRICE BLVD
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34286-6819
Country	:	US
Telephone Number	:	941-769-2474
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. MARIA BARAJAS
Credential	:
Telephone Number	:	941-769-2474

Provider Enumeration Date	:	10/05/2011
Last Update Date	:	10/05/2011

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