Healthcare Provider Details

I. General information

NPI: 1649100389
Provider Name (Legal Business Name): WEST BRADENTON THERAPY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 6TH AVE W STE 100
BRADENTON FL
34205-7413
US

IV. Provider business mailing address

1201 6TH AVE W STE 100
BRADENTON FL
34205-7413
US

V. Phone/Fax

Practice location:
  • Phone: 941-241-0294
  • Fax:
Mailing address:
  • Phone: 941-241-0294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN SANDUSKY
Title or Position: OWNER CEO
Credential: LMHC
Phone: 941-241-0294