Healthcare Provider Details

I. General information

NPI: 1396404927
Provider Name (Legal Business Name): ALL BREVARD COUNTY THERAPY STAFFING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 07/10/2022
Certification Date: 07/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 WICKHAM LAKES DR
MELBOURNE FL
32940-2227
US

IV. Provider business mailing address

711 WICKHAM LAKES DR
MELBOURNE FL
32940-2227
US

V. Phone/Fax

Practice location:
  • Phone: 321-917-4435
  • Fax:
Mailing address:
  • Phone: 321-917-4435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. BRIAN JOSEPH BALGO
Title or Position: OWNER
Credential: PT
Phone: 321-917-4435