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General NPI Number Information
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NPI Number | 1740169382
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Entity Type | Individual
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Provider Name | HEATHER BRIDGHAM IVES DPT
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Gender | Female
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Dates
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Enumeration Date | 08/28/2025
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 4660 MAIN ST STE 600-1
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City | SPRINGFIELD
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State | OR
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Zip | 97478-4021
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Country | US
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Telephone | 541-683-5187
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Fax | 541-689-4525
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Provider Business Mailing Address
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Address Line | 4660 MAIN ST STE 600-1
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City | SPRINGFIELD
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State | OR
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Zip | 97478-4021
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Country | US
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Telephone | 541-683-5187
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Fax | 541-689-4525
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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 | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2251N0400X
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Taxonomy Name | Neurology Physical Therapist
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License Number |
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License Number State |
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Taxonomy #4
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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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