Provider Demographics
NPI:1114393246
Name:BLEVINS, BRIDGET (PTA)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:
Other - Last Name:VIRDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:5800 E SKELLY DR
Mailing Address - Street 2:SUITE 402
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-6471
Mailing Address - Country:US
Mailing Address - Phone:918-497-1068
Mailing Address - Fax:918-497-1069
Practice Address - Street 1:5800 E SKELLY DR
Practice Address - Street 2:SUITE 402
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5712
Practice Address - Country:US
Practice Address - Phone:918-497-1068
Practice Address - Fax:918-497-1069
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK155225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant