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General NPI Number Information
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NPI Number | 1063865699
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Entity Type | Individual
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Provider Name | BRIDGER PARK DPT
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Gender | Male
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Dates
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Enumeration Date | 07/19/2016
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 253 NEW MARKET CTR
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City | BOONE
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State | NC
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Zip | 28607-3993
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Country | US
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Telephone | 828-386-1719
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 CORPORATE DR STE 400
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City | HOOVER
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State | AL
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Zip | 35242-5424
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Country | US
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Telephone | 423-497-0005
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 3095297-8016
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License Number State | UT
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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 | P16769
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License Number State | NC
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