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NPI Code Detail

MEDICARE: BRIGHT MINDS PEDIATRIC THERAPY LLC.

MEDICARE: BRIGHT MINDS PEDIATRIC THERAPY LLC.
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1252Y00000XEarly Intervention Provider Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1275277469
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRIGHT MINDS PEDIATRIC THERAPY LLC.
Provider Business Mailing Address
First Line : 4097 SUSSEX AVE
Second Line :
City : LAKE WORTH
State : FL
Zip : 33461-1719
Country : US
Telephone Number : 786-537-5904
Fax Number :
Provider Business Practice Location Address
First Line : 4097 SUSSEX AVE
Second Line :
City : LAKE WORTH
State : FL
Zip : 33461-1719
Country : US
Telephone Number : 786-537-5904
Fax Number :
Authorized Official
Title or Position : OWNER
Name : NOLEYS GOMEZ
Credential :
Telephone Number : 786-537-5904
Provider Enumeration Date : 04/24/2022
Last Update Date : 08/24/2022

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Directions to “BRIGHT MINDS PEDIATRIC THERAPY LLC. ” Practice Location

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