Provider Demographics
NPI:1073807731
Name:KURTZ, DERSHIE BRIDGFORD (PT)
Entity Type:Individual
Prefix:
First Name:DERSHIE
Middle Name:BRIDGFORD
Last Name:KURTZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 PRADO XING
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-8260
Mailing Address - Country:US
Mailing Address - Phone:830-230-5433
Mailing Address - Fax:830-230-5433
Practice Address - Street 1:555 PRADO XING
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-8260
Practice Address - Country:US
Practice Address - Phone:830-230-5433
Practice Address - Fax:830-230-5433
Is Sole Proprietor?:No
Enumeration Date:2011-05-30
Last Update Date:2011-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1112969225100000X
225XP0019X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist