Healthcare Provider Details

I. General information

NPI: 1508928789
Provider Name (Legal Business Name): BRIGHTSTART PEDIATRICS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12377 S ORANGE BLOSSOM TRL
ORLANDO FL
32837-6215
US

IV. Provider business mailing address

12377 S ORANGE BLOSSOM TRL
ORLANDO FL
32837-6215
US

V. Phone/Fax

Practice location:
  • Phone: 407-857-1212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT20498
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 2392
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT12396
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 2693
License Number StateFL

VIII. Authorized Official

Name: LINDA BROWN
Title or Position: MANAGING MEMBER
Credential:
Phone: 407-857-1212