Healthcare Provider Details

I. General information

NPI: 1174197073
Provider Name (Legal Business Name): BRIGHTSIDE THERAPY, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2021
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7512 CYPRESS GARDENS BLVD
WINTER HAVEN FL
33884-3200
US

IV. Provider business mailing address

7512 CYPRESS GARDENS BLVD
WINTER HAVEN FL
33884-3200
US

V. Phone/Fax

Practice location:
  • Phone: 321-337-6243
  • Fax: 352-717-6829
Mailing address:
  • Phone:
  • Fax: 352-717-6829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ISABELLA MARTINEZ
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential:
Phone: 321-337-6243