Healthcare Provider Details

I. General information

NPI: 1598379794
Provider Name (Legal Business Name): BUILDING PATHWAYS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 09/04/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 CHESHIRE BRIDGE RD NE APT 2006
ATLANTA GA
30324-5731
US

IV. Provider business mailing address

7200 MYSTIC BROOK WAY
DAVENPORT FL
33896-6703
US

V. Phone/Fax

Practice location:
  • Phone: 863-651-3684
  • Fax:
Mailing address:
  • Phone: 186-365-1368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: JUDLANDE GUERVIL
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 863-651-3684