=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326370008
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RESILIENCE REHAB & EDUCATIONAL SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2010
-----------------------------------------------------
Last Update Date | 04/18/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 407 LITHIA PINECREST RD
-----------------------------------------------------
City | BRANDON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33511-6138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-681-4741
-----------------------------------------------------
Fax | 888-834-7415
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 507 BRANTWOOD CT
-----------------------------------------------------
City | VALRICO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33594-2905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-320-4098
-----------------------------------------------------
Fax | 888-834-7415
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH LANG PATHOLOGIST/OWNER
-----------------------------------------------------
Name | MARIA BRYANT-JONES
-----------------------------------------------------
Credential | M.A. CCC-SLP
-----------------------------------------------------
Telephone | 727-320-4098
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0700X
-----------------------------------------------------
Taxonomy Name | Hearing and Speech Clinic/Center
-----------------------------------------------------
License Number | SA8958
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------