MEDICARE: MBJ 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	261QR0400X	Rehabilitation Clinic/Center	36875	CA

General Provider Information

NPI Number	:	1548650369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MBJ THERAPY, LLC

Provider Business Mailing Address
First Line	:	2385 ROSCOMARE RD UNIT E8
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90077-1821
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11620 W WASHINGTON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-5916
Country	:	US
Telephone Number	:	781-864-8252
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	MELANIE BARKER
Credential	:
Telephone Number	:	781-864-8252

Provider Enumeration Date	:	02/02/2015
Last Update Date	:	02/02/2015

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