| The Brain Factory Llc | |
|
7575 Dr Phillips Blvd Ste 120 Orlando FL 32819-7221 | |
| (407) 375-7871 | |
| (407) 209-3503 |
| Full Name | The Brain Factory Llc |
|---|---|
| Speciality | Clinic/center |
| Location | 7575 Dr Phillips Blvd Ste 120, Orlando, Florida |
| Authorized Official Name and Position | Susan Shortridge (PRESIDENT) |
| Authorized Official Contact | 4073757871 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Brain Factory Llc 1110 Sw Ivanhoe Blvd #2 Orlando FL 32804-6305 Ph: (407) 375-7871 | The Brain Factory Llc 7575 Dr Phillips Blvd Ste 120 Orlando FL 32819-7221 Ph: (407) 375-7871 |
| NPI Number | 1164764049 |
|---|---|
| Provider Enumeration Date | 03/19/2013 |
| Last Update Date | 03/19/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164764049 | NPI | - | NPPES |
| OT 00544 | Other | FL | OT LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | OT 00544 (Florida) | Primary |
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