Healthcare Provider Details

I. General information

NPI: 1134457641
Provider Name (Legal Business Name): BRIDGET TARRANT PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2009
Last Update Date: 11/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 N MICHIGAN AVE SUITE 410
CHICAGO IL
60611-2826
US

IV. Provider business mailing address

3619 VERNON AVE
BROOKFIELD IL
60513-1613
US

V. Phone/Fax

Practice location:
  • Phone: 312-274-0197
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070006228
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: