MEDICARE: BRIDGETTE TOWNSEND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2293	OK

General Provider Information

NPI Number	:	1457940553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGETTE TOWNSEND

Provider Business Mailing Address
First Line	:	PO BOX 240
Second Line	:
City	:	CARNEY
State	:	OK
Zip	:	74832-0240
Country	:	US
Telephone Number	:	405-865-2344
Fax Number	:	405-865-2345

Provider Business Practice Location Address
First Line	:	204 S CARNEY
Second Line	:
City	:	CARNEY
State	:	OK
Zip	:	74832-9625
Country	:	US
Telephone Number	:	405-865-2344
Fax Number	:	405-865-2345

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2021
Last Update Date	:	01/13/2021

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Directions to “ BRIDGETTE TOWNSEND ” Practice Location

Language	Start Address	Practice Location

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