Healthcare Provider Details

I. General information

NPI: 1487599528
Provider Name (Legal Business Name): SIERRA BRIDGETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 THOMAS JOHNSON DR STE 100
FREDERICK MD
21702-4952
US

IV. Provider business mailing address

86 THOMAS JOHNSON CT STE 100
FREDERICK MD
21702-4348
US

V. Phone/Fax

Practice location:
  • Phone: 301-579-7811
  • Fax:
Mailing address:
  • Phone: 301-273-7770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: