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General NPI Number Information
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NPI Number | 1104126572
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Entity Type | Organization
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Legal Business Name | BRIDGE OF HOPE OF CENTRAL FLORIDA CORP
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Dates
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Enumeration Date | 11/01/2010
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Last Update Date | 08/19/2015
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Provider Practice Location Address
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Address Line | 1300 KEVSTIN DR
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City | KISSIMMEE
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State | FL
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Zip | 34744-5843
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Country | US
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Telephone | 407-575-4636
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Fax | 321-250-7425
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Provider Business Mailing Address
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Address Line | PO BOX 452878
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City | KISSIMMEE
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State | FL
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Zip | 34745-2878
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Country | US
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Telephone | 407-575-4636
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Fax | 407-343-5599
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Authorized Official
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Title or Position | C.E.O.
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Name | VANESSA ROMAN
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Credential | BA
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Telephone | 407-575-4636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT 24417
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | OT 11560
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | SA 8292
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License Number State | FL
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