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General NPI Number Information
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NPI Number | 1942519103
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Entity Type | Organization
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Legal Business Name | METAMORPHOSIS THERAPY, LLC
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Dates
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Enumeration Date | 10/05/2010
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 1450 DANIELS RD
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City | WINTER GARDEN
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State | FL
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Zip | 34787-4376
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Country | US
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Telephone | 407-395-9976
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Fax | 407-992-9368
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Provider Business Mailing Address
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Address Line | 13750 W COLONIAL DR STE 350-121
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City | WINTER GARDEN
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State | FL
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Zip | 34787-4204
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Country | US
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Telephone | 407-395-9976
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Fax | 407-992-9368
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | MRS. BRIDGETT ELAINE DIMANT
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Credential | MS, CCC-SLP
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Telephone | 407-285-7907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 017434700
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 225XF0002X
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Taxonomy Name | Feeding, Eating & Swallowing Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA 9096
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License Number State | FL
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