Healthcare Provider Details

I. General information

NPI: 1457730228
Provider Name (Legal Business Name): BRIGHTER FUTURES THERAPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 S HIGHWAY 27 STE 9
SOMERSET KY
42501-2893
US

IV. Provider business mailing address

1056 S HIGHWAY 27 STE 9
SOMERSET KY
42501-2893
US

V. Phone/Fax

Practice location:
  • Phone: 606-677-1166
  • Fax: 606-677-0693
Mailing address:
  • Phone: 606-677-1166
  • Fax: 606-677-0693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number001108
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number001108
License Number StateKY

VIII. Authorized Official

Name: MRS. PAULA JANE GIBSON
Title or Position: OCCUPATIONAL THERAPIST/ OWNER
Credential: OTR/L
Phone: 606-677-1166