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General NPI Number Information
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NPI Number | 1508928789
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Entity Type | Organization
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Legal Business Name | BRIGHTSTART PEDIATRICS,LLC
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 04/30/2008
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Provider Practice Location Address
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Address Line | 12377 S ORANGE BLOSSOM TRL
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City | ORLANDO
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State | FL
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Zip | 32837-6215
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Country | US
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Telephone | 407-857-1212
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Fax |
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Provider Business Mailing Address
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Address Line | 12377 S ORANGE BLOSSOM TRL
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City | ORLANDO
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State | FL
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Zip | 32837-6215
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | LINDA BROWN
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Credential |
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Telephone | 407-857-1212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | PT20498
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT 2392
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT12396
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA 2693
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License Number State | FL
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