MEDICARE: MBRACE HAND THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261Q00000X	Clinic/Center
2	332BC3200X	Customized Equipment (DME)
3	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1639760069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MBRACE HAND THERAPY LLC

Provider Business Mailing Address
First Line	:	PO BOX 47413
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85068-7413
Country	:	US
Telephone Number	:	602-641-4263
Fax Number	:

Provider Business Practice Location Address
First Line	:	4643 N 12TH ST STE 101
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-4083
Country	:	US
Telephone Number	:	602-641-4263
Fax Number	:	602-641-4262

Authorized Official
Title or Position	:	OWNER
Name	:	MEGHAN LEONARD
Credential	:
Telephone Number	:	503-317-4367

Provider Enumeration Date	:	01/28/2021
Last Update Date	:	01/28/2021

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Directions to “MBRACE HAND THERAPY LLC ” Practice Location

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