Provider Demographics
NPI:1093801532
Name:BRIDGES, JOSEPH WESLEY (PT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:WESLEY
Last Name:BRIDGES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:JOE
Other - Middle Name:WESLEY
Other - Last Name:BRIDGES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:3239 EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72936-5963
Mailing Address - Country:US
Mailing Address - Phone:479-996-3067
Mailing Address - Fax:
Practice Address - Street 1:1500 DODSON AVE
Practice Address - Street 2:SUITE 55
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-5182
Practice Address - Country:US
Practice Address - Phone:479-646-2373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1581225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U327Medicare ID - Type Unspecified