Organization
SHINE-PEDIATRIC THERAPY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY A BRYCE-TRAVIS MOT/L (OWNER)
(850) 353-2415
Entity
Organization
Contact information
Practice address
4565 COMMERCIAL DR STE 105, NICEVILLE, FL 32578-8856
(850) 353-2415
(850) 353-2528
Mailing address
4565 COMMERCIAL DR STE 105, NICEVILLE, FL 32578-8856
(850) 353-2415
(850) 353-2528
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
04/25/2022
Last updated
03/10/2026
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