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NPI Code Detail

MEDICARE: BRIGHT STAR THERAPY LLC

MEDICARE: BRIGHT STAR 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
1103K00000XBehavior Analyst
21041C0700XClinical Social Worker
3225100000XPhysical Therapist
4235Z00000XSpeech-Language Pathologist
5225X00000XOccupational Therapist

General Provider Information

NPI Number : 1518355304
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRIGHT STAR THERAPY LLC
Provider Business Mailing Address
First Line : 125 NED DR
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-5101
Country : US
Telephone Number : 732-905-1212
Fax Number : 732-612-1156
Provider Business Practice Location Address
First Line : 125 NED DR
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-5101
Country : US
Telephone Number : 732-905-1212
Fax Number : 732-612-1156
Authorized Official
Title or Position : OWNER
Name : YUTA WEISS
Credential : SLP
Telephone Number : 732-905-1212
Provider Enumeration Date : 12/31/2014
Last Update Date : 08/31/2016

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Directions to “BRIGHT STAR THERAPY LLC ” Practice Location

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