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General NPI Number Information
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NPI Number | 1184346884
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Entity Type | Organization
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Legal Business Name | BRIDGEROOT LLC
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Dates
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Enumeration Date | 09/19/2022
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Last Update Date | 09/19/2022
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Provider Practice Location Address
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Address Line | 11400 W OLYMPIC BLVD STE 200
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City | LOS ANGELES
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State | CA
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Zip | 90064-1584
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Country | US
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Telephone | 800-965-6024
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Fax |
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Provider Business Mailing Address
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Address Line | 6104 SEPULVEDA BLVD # 1024
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City | VAN NUYS
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State | CA
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Zip | 91411-2503
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Country | US
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Telephone | 646-833-6331
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Fax |
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Authorized Official
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Title or Position | MEDICAL MASSAGE THERAPIST
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Name | TAKIESHA INDIGO MELENDEZ
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Credential | LMT
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Telephone | 800-965-6024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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