Provider Demographics
NPI:1952171928
Name:MRJ THERAPY LLC
Entity Type:Organization
Organization Name:MRJ THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTOBANCO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:786-394-0096
Mailing Address - Street 1:18350 NW 2ND AVE STE 308
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4566
Mailing Address - Country:US
Mailing Address - Phone:786-394-0096
Mailing Address - Fax:
Practice Address - Street 1:18350 NW 2ND AVE STE 308
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-4566
Practice Address - Country:US
Practice Address - Phone:786-394-0096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health