MEDICARE: JB MOBILE THERAPY CORP.

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	225700000X	Massage Therapist	MA62130	FL

General Provider Information

NPI Number	:	1851668180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JB MOBILE THERAPY CORP.

Provider Business Mailing Address
First Line	:	1838 NW FLAGLER TER APT 7
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-5425
Country	:	US
Telephone Number	:	786-426-2658
Fax Number	:

Provider Business Practice Location Address
First Line	:	1838 NW FLAGLER TER APT 7
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-5425
Country	:	US
Telephone Number	:	786-426-2658
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JAVIER BARRO
Credential	:
Telephone Number	:	786-426-2658

Provider Enumeration Date	:	12/01/2011
Last Update Date	:	12/01/2011

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