Healthcare Provider Details

I. General information

NPI: 1457940553
Provider Name (Legal Business Name): BRIDGETTE TOWNSEND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 S CARNEY
CARNEY OK
74832-9625
US

IV. Provider business mailing address

PO BOX 240
CARNEY OK
74832-0240
US

V. Phone/Fax

Practice location:
  • Phone: 405-865-2344
  • Fax: 405-865-2345
Mailing address:
  • Phone: 405-865-2344
  • Fax: 405-865-2345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2293
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: