Healthcare Provider Details

I. General information

NPI: 1326200452
Provider Name (Legal Business Name): BUILDING BRIDGES THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1389 WEBER INDUSTRIAL DR
CUMMING GA
30041-6468
US

IV. Provider business mailing address

1389 WEBER INDUSTRIAL DR
CUMMING GA
30041-6468
US

V. Phone/Fax

Practice location:
  • Phone: 770-886-6204
  • Fax: 678-261-6421
Mailing address:
  • Phone: 770-886-6204
  • Fax: 678-261-6421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateGA

VIII. Authorized Official

Name: MARLA MANN
Title or Position: OWNER, SPEECH LANGUAGE PATHOLOGIST
Credential: M.ED, CCC-SLP
Phone: 770-886-6204