Healthcare Provider Details

I. General information

NPI: 1134570054
Provider Name (Legal Business Name): BRIDGES OF POSSIBILITIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1579 E 85TH AVE
MERRILLVILLE IN
46410-8901
US

IV. Provider business mailing address

PO BOX 10371
MERRILLVILLE IN
46411-0371
US

V. Phone/Fax

Practice location:
  • Phone: 219-525-4973
  • Fax:
Mailing address:
  • Phone: 219-525-4973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: PAULA SIMPSON
Title or Position: PRACTICE MANAGER/EXECUTIVE DIRECTOR
Credential:
Phone: 219-525-4973