Healthcare Provider Details

I. General information

NPI: 1548548779
Provider Name (Legal Business Name): BRIGHTON REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 E ORANGEBURG AVE
MODESTO CA
95350-5510
US

IV. Provider business mailing address

1952 E 7000 S #100
SALT LAKE CITY UT
84121-6877
US

V. Phone/Fax

Practice location:
  • Phone: 209-529-0516
  • Fax: 209-527-1670
Mailing address:
  • Phone: 801-942-3311
  • Fax: 801-942-5955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MELISSA GUSS-HOFFELMEYER
Title or Position: PRESIDENT
Credential:
Phone: 801-942-3311