MEDICARE: BRIGHTSIDE THERAPY, LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist
3	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1174197073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHTSIDE THERAPY, LLC.

Provider Business Mailing Address
First Line	:	7512 CYPRESS GARDENS BLVD
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884-3200
Country	:	US
Telephone Number	:
Fax Number	:	352-717-6829

Provider Business Practice Location Address
First Line	:	7512 CYPRESS GARDENS BLVD
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884-3200
Country	:	US
Telephone Number	:	321-337-6243
Fax Number	:	352-717-6829

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	ISABELLA MARTINEZ
Credential	:
Telephone Number	:	321-337-6243

Provider Enumeration Date	:	05/14/2021
Last Update Date	:	12/07/2023

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Directions to “BRIGHTSIDE THERAPY, LLC. ” Practice Location

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