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NPI Code Detail

MEDICARE: MR. EARL BRIDGES IV DPT

MEDICARE: MR. EARL BRIDGES IV DPT
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
1225100000XPhysical Therapist1310432TX

General Provider Information

NPI Number : 1932681103
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EARL BRIDGES IV DPT
Provider Business Mailing Address
First Line : 6020 W PARKER RD STE 240
Second Line :
City : PLANO
State : TX
Zip : 75093-0004
Country : US
Telephone Number : 972-378-1434
Fax Number : 972-378-1432
Provider Business Practice Location Address
First Line : 6020 W PARKER RD STE 240
Second Line :
City : PLANO
State : TX
Zip : 75093-0004
Country : US
Telephone Number : 972-378-1434
Fax Number : 972-378-1432
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2018
Last Update Date : 09/04/2018

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