Provider Demographics
NPI:1164046165
Name:JOHNSON, BRIDGETT (RRT)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGETT
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 W MONTGOMERY ST # 323
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77378-8827
Mailing Address - Country:US
Mailing Address - Phone:281-932-9088
Mailing Address - Fax:
Practice Address - Street 1:9074 N COMANCHE CIR
Practice Address - Street 2:
Practice Address - City:WILLIS
Practice Address - State:TX
Practice Address - Zip Code:77378-4958
Practice Address - Country:US
Practice Address - Phone:281-932-9088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRCP00063210227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered