# BRIDGE TO BRILLIANCE THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114707700
- **Authorized official:** ANISA MOHAMED AHMED (OWNER)
- **Authorized official phone:** (612) 987-3455

## Contact information

- **Practice address:** 13740 NICOLLET AVE, BURNSVILLE, MN 55337-4003
- **Practice address phone:** (612) 987-3455
- **Mailing address:** 7764 OAKRIDGE TRL, SHAKOPEE, MN 55379-5509
- **Mailing address phone:** (612) 987-3455

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 252Y00000X | Early Intervention Provider Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 10/02/2023
- **Last updated:** 10/02/2023