Provider Demographics
NPI:1801413885
Name:BRIGHT STRIDES SPEECH THERAPY LLC
Entity Type:Organization
Organization Name:BRIGHT STRIDES SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH LANG. PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ANISSA
Authorized Official - Middle Name:C
Authorized Official - Last Name:WEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:MS/CCC-SLP
Authorized Official - Phone:434-352-1396
Mailing Address - Street 1:PO BOX 1070
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:VA
Mailing Address - Zip Code:24557
Mailing Address - Country:US
Mailing Address - Phone:434-352-1396
Mailing Address - Fax:434-656-1959
Practice Address - Street 1:102 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:VA
Practice Address - Zip Code:24557
Practice Address - Country:US
Practice Address - Phone:434-352-1396
Practice Address - Fax:434-656-1959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-25
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty