Healthcare Provider Details

I. General information

NPI: 1023644432
Provider Name (Legal Business Name): BRIDGE PT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 3RD AVE
CHESAPEAKE OH
45619-1140
US

IV. Provider business mailing address

PO BOX 24
CHESAPEAKE OH
45619-0024
US

V. Phone/Fax

Practice location:
  • Phone: 304-544-5299
  • Fax: 740-422-0516
Mailing address:
  • Phone: 740-550-4128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JARED BLANKENSHIP
Title or Position: OWNER
Credential: PT, DPT, OCS
Phone: 740-550-4128