Provider Demographics
NPI:1376278606
Name:GULF BREEZE THERAPY, LLC
Entity Type:Organization
Organization Name:GULF BREEZE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIESKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-716-2693
Mailing Address - Street 1:210 FIRETHORN RD
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-4318
Mailing Address - Country:US
Mailing Address - Phone:850-737-6864
Mailing Address - Fax:
Practice Address - Street 1:2705 GULF BREEZE PKWY
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-3047
Practice Address - Country:US
Practice Address - Phone:850-737-6864
Practice Address - Fax:855-682-6103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty