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General NPI Number Information
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NPI Number | 1023644432
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Entity Type | Organization
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Legal Business Name | BRIDGE PT, LLC
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Dates
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Enumeration Date | 03/17/2020
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Last Update Date | 03/03/2021
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Provider Practice Location Address
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Address Line | 129 3RD AVE
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City | CHESAPEAKE
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State | OH
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Zip | 45619-1140
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Country | US
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Telephone | 304-544-5299
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Fax | 740-422-0516
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Provider Business Mailing Address
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Address Line | PO BOX 24
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City | CHESAPEAKE
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State | OH
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Zip | 45619-0024
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Country | US
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Telephone | 740-550-4128
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JARED BLANKENSHIP
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Credential | PT, DPT, OCS
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Telephone | 740-550-4128
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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