Provider Demographics
NPI:1659929677
Name:MSB THERAPY, P.A
Entity Type:Organization
Organization Name:MSB THERAPY, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIRELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVA-BASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-336-6044
Mailing Address - Street 1:2250 NW 136 AVE # 100F
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2586
Mailing Address - Country:US
Mailing Address - Phone:954-336-6044
Mailing Address - Fax:
Practice Address - Street 1:2250 NW 136 AVE # 100F
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2586
Practice Address - Country:US
Practice Address - Phone:954-336-6044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty