MEDICARE: CBM 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	225100000X	Physical Therapist	2006005286	MO
2	225100000X	Physical Therapist	70005018	IL

General Provider Information

NPI Number	:	1952676694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CBM THERAPY LLC

Provider Business Mailing Address
First Line	:	4700 PEBBLE BEACH DR
Second Line	:
City	:	QUINCY
State	:	IL
Zip	:	62305-6098
Country	:	US
Telephone Number	:	217-228-2262
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 PEBBLE BEACH DR
Second Line	:
City	:	QUINCY
State	:	IL
Zip	:	62305-6098
Country	:	US
Telephone Number	:	217-228-2262
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MRS. CAROLYN B MUSHOLT
Credential	:	PT
Telephone Number	:	217-228-2262

Provider Enumeration Date	:	03/13/2012
Last Update Date	:	03/13/2012

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Directions to “CBM THERAPY LLC ” Practice Location

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