=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336081181
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIDGE PT, OT & SPEECH SERVICES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2026
-----------------------------------------------------
Last Update Date | 04/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16316 84TH ST
-----------------------------------------------------
City | HOWARD BEACH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11414-3319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-541-3575
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16316 84TH ST
-----------------------------------------------------
City | HOWARD BEACH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11414-3319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-541-3575
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. JUSTINE CLIFFORD
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 718-541-3575
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171W00000X
-----------------------------------------------------
Taxonomy Name | Contractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------