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General NPI Number Information
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NPI Number | 1245678184
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Entity Type | Organization
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Legal Business Name | BRIDGE OF HOPE CENTRAL FLORIDA
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Dates
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Enumeration Date | 06/13/2013
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Last Update Date | 06/13/2013
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Provider Practice Location Address
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Address Line | 1331 KEVSTIN DR
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City | KISSIMMEE
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State | FL
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Zip | 34744-5844
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Country | US
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Telephone | 407-575-4536
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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 | 321-250-7425
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Authorized Official
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Title or Position | OPERATION MANAGER
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Name | HECTOR L RODRIGUEZ
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Credential | AS
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT 21145
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT 1181
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA10475
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License Number State | FL
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