Blue Bridge Therapy Center LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

BLUE BRIDGE THERAPY CENTER LLC

Practice address

4531 Deleon St Ste 212
Fort Myers, FL 33907-1279

Phone

(786) 534-8773

NPI assigned

Jul 21, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Dayani Aguirre, M.S., CCC-SLP

Title

Co Owner

Phone

(786) 534-8773

Specialties & licenses 3

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1595289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596412800000",
    "number": "1972111425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4531 DELEON ST STE 212",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339071279",
            "telephone_number": "786-534-8773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4531 DELEON ST STE 212",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339071279",
            "telephone_number": "786-534-8773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE BRIDGE THERAPY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-21",
        "last_updated": "2020-08-03",
        "certification_date": "2020-08-03",
        "status": "A",
        "authorized_official_last_name": "AGUIRRE",
        "authorized_official_first_name": "DAYANI",
        "authorized_official_title_or_position": "CO OWNER",
        "authorized_official_telephone_number": "786-534-8773",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.S., CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.