Provider Demographics
NPI:1447493226
Name:BRIGHT HORIZON REHAB THERAPY, LLC
Entity type:Organization
Organization Name:BRIGHT HORIZON REHAB THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:FASANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-334-5299
Mailing Address - Street 1:PO BOX 2477
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85299-2477
Mailing Address - Country:US
Mailing Address - Phone:623-334-5299
Mailing Address - Fax:480-635-0222
Practice Address - Street 1:8718 W DEER VALLEY RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2453
Practice Address - Country:US
Practice Address - Phone:623-334-5299
Practice Address - Fax:480-635-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
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