Healthcare Provider Details

I. General information

NPI: 1811712730
Provider Name (Legal Business Name): BRIDGET BRENNAN WEBB I PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2024
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3809 LEMAY FERRY RD
SAINT LOUIS MO
63125-4535
US

IV. Provider business mailing address

10278 EDDINGHAM TER
SAINT LOUIS MO
63128-2618
US

V. Phone/Fax

Practice location:
  • Phone: 314-939-1377
  • Fax:
Mailing address:
  • Phone: 314-221-1659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number2002007086
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: