Provider Demographics
NPI:1083035257
Name:MCGRATH, BRIDGET (CSCS, CNS, CES, APT)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:MCGRATH
Suffix:
Gender:F
Credentials:CSCS, CNS, CES, APT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11574
Mailing Address - Street 2:
Mailing Address - City:ZEPHYR COVE
Mailing Address - State:NV
Mailing Address - Zip Code:89448-3574
Mailing Address - Country:US
Mailing Address - Phone:530-318-8666
Mailing Address - Fax:
Practice Address - Street 1:4000 LAKE TAHOE BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7071
Practice Address - Country:US
Practice Address - Phone:530-318-8666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6227133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist