Provider Demographics
NPI:1558049015
Name:UPBEAT MUSIC THERAPY
Entity Type:Organization
Organization Name:UPBEAT MUSIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MINDA
Authorized Official - Middle Name:KISBER
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MT-BC
Authorized Official - Phone:904-993-8940
Mailing Address - Street 1:1401 ARCHER CT
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-3040
Mailing Address - Country:US
Mailing Address - Phone:904-993-8940
Mailing Address - Fax:
Practice Address - Street 1:1401 ARCHER CT
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-3040
Practice Address - Country:US
Practice Address - Phone:904-993-8940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty