Provider Demographics
NPI:1104177740
Name:HONEYCUTT, BRIDGET TULLY (PT)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:TULLY
Last Name:HONEYCUTT
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 1:665 DOLORES LN
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-4020
Mailing Address - Country:US
Mailing Address - Phone:805-674-2144
Mailing Address - Fax:
Practice Address - Street 1:809 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:KING CITY
Practice Address - State:CA
Practice Address - Zip Code:93930-3303
Practice Address - Country:US
Practice Address - Phone:831-385-6835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-22
Last Update Date:2012-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10857225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist