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General NPI Number Information
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NPI Number | 1225035736
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Entity Type | Organization
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Legal Business Name | BRIDDELL PHYSICAL THERAPY
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Dates
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Enumeration Date | 06/30/2005
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Last Update Date | 08/17/2007
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Provider Practice Location Address
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Address Line | 1666 WIMBLEDON DR APT 204
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City | GREENVILLE
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State | NC
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Zip | 27858-5392
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Country | US
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Telephone | 410-251-4467
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1651
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City | GREENVILLE
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State | NC
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Zip | 27835-1651
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Country | US
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Telephone | 410-251-4467
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | DR. DERRICK ANTONIO BRIDDELL
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Credential | PT, DSC, MS, SCS
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Telephone | 410-251-4467
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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 | 5297
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 17958
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | J1-0001697
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License Number State | DE
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Taxonomy #4
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 11098
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License Number State | NC
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