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Organization

THE BRAIN FACTORY LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. SUSAN SHORTRIDGE (PRESIDENT)
(407) 375-7871
Entity
Organization

Contact information

Practice address
7575 DR PHILLIPS BLVD STE 120, ORLANDO, FL 32819-7221
(407) 375-7871
(407) 209-3503
Mailing address
1110 SW IVANHOE BLVD, #2, ORLANDO, FL 32804-6305
(407) 375-7871

Taxonomy

Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
OT 00544
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
OT 00544
OT LICENSE
FL
Enumeration date
03/19/2013
Last updated
03/19/2013
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