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: |