Healthcare Provider Details

I. General information

NPI: 1942519103
Provider Name (Legal Business Name): METAMORPHOSIS THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 DANIELS RD
WINTER GARDEN FL
34787-4376
US

IV. Provider business mailing address

13750 W COLONIAL DR STE 350-121
WINTER GARDEN FL
34787-4204
US

V. Phone/Fax

Practice location:
  • Phone: 407-395-9976
  • Fax: 407-992-9368
Mailing address:
  • Phone: 407-395-9976
  • Fax: 407-992-9368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 9096
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 8
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number017434700
License Number StateFL
# 9
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. BRIDGETT ELAINE DIMANT
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: MS, CCC-SLP
Phone: 407-285-7907