NPI 1114707700

Bridge to Brilliance Therapy LLC

Organisation Early Intervention Provider Agency Burnsville, MN

Practice location

Address: 13740 Nicollet Ave, Burnsville, MN 55337-4003
Phone: (612) 987-3455
Mailing address: 7764 Oakridge Trl, Shakopee, MN 55379-5509

Authorised official

Name: Anisa Mohamed Ahmed
Title: Owner
Phone: (612) 987-3455

Registered specialties

Early Intervention Provider Agency Primary

Agencies Taxonomy 252Y00000X

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Registry record

NPI: 1114707700
Entity type: Organization
NPI issued: 2 Oct 2023
Record last updated: 2 Oct 2023

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.