Healthcare Provider Details

I. General information

NPI: 1164046165
Provider Name (Legal Business Name): BRIDGETT JOHNSON RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9074 N COMANCHE CIR
WILLIS TX
77378-4958
US

IV. Provider business mailing address

502 W MONTGOMERY ST # 323
WILLIS TX
77378-8827
US

V. Phone/Fax

Practice location:
  • Phone: 281-932-9088
  • Fax:
Mailing address:
  • Phone: 281-932-9088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRCP00063210
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: