Provider Demographics
NPI:1073727418
Name:BLUNK, BRIDGET MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:MARIE
Last Name:BLUNK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:MARIE
Other - Last Name:MCMANUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2300 53RD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-7565
Mailing Address - Country:US
Mailing Address - Phone:563-322-0971
Mailing Address - Fax:
Practice Address - Street 1:2300 53RD AVE STE LL02
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-7565
Practice Address - Country:US
Practice Address - Phone:563-449-7000
Practice Address - Fax:563-449-7099
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004659225100000X
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA004659OtherLICENSE