Provider Demographics
NPI:1467863464
Name:BRIDGE DISABILITY NETWORK, INC.
Entity Type:Organization
Organization Name:BRIDGE DISABILITY NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF THERAPY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:EBANKS-NUNAIHED
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:954-699-4690
Mailing Address - Street 1:500 N PARK RD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6905
Mailing Address - Country:US
Mailing Address - Phone:954-894-9023
Mailing Address - Fax:
Practice Address - Street 1:500 N PARK RD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6905
Practice Address - Country:US
Practice Address - Phone:954-894-9023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10164261QH0700X
FLPT27161261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008612500Medicaid
FL002014300Medicaid