Most Relevant Information
Provider Data
| NPI Number: | 1003289620 |
| Provider Name: | BRIDGET ROSE PTA |
| Entity Type: | Individual |
| Taxonomy Code: | 225200000X |
| Specialty: | Physical Therapy Assistant |
| License Number: | 160005138 |
Most Important Dates
| Enumeration Date: | 11/04/2015 |
| Last Updated: | 11/04/2015 |
Provider Practice Location
600 W OWENS ST
CARBONDALE
IL
629011246
Practice Location Phone/Fax
| Phone: | 6189675186 |
| Fax: |
Provider Mailing Location
600 W OWENS ST
CARBONDALE
IL
629011246
Provider Mailing Phone/Fax
| Phone: | 6189675186 |
| Fax: |