Provider Demographics
NPI:1477983153
Name:BRIDGE OF HOPE
Entity Type:Organization
Organization Name:BRIDGE OF HOPE
Other - Org Name:BRIDGE OF HOPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ULYSSES
Authorized Official - Middle Name:D
Authorized Official - Last Name:SINGLETON
Authorized Official - Suffix:III
Authorized Official - Credentials:DR
Authorized Official - Phone:407-575-4636
Mailing Address - Street 1:PO BOX 452878
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34745-2878
Mailing Address - Country:US
Mailing Address - Phone:407-575-4636
Mailing Address - Fax:321-250-7425
Practice Address - Street 1:1331 KEVSTIN DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5844
Practice Address - Country:US
Practice Address - Phone:407-575-4636
Practice Address - Fax:321-250-7425
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FUNCTIONAL PHYSICAL THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 21146225100000X
FLOT 13138225X00000X
FLSA 10194235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty