Provider Demographics
NPI:1225090350
Name:BRIDGES, JASON M (PT, MSPT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:M
Last Name:BRIDGES
Suffix:
Gender:M
Credentials:PT, MSPT
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 69030
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-9030
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:10128 W BROAD ST BLDG III
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6761
Practice Address - Country:US
Practice Address - Phone:804-217-9210
Practice Address - Fax:804-217-9213
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203424225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8953023Medicaid
VA192953OtherBCBS PHYSICAL THERAPY
VA7914439OtherAETNA
VA650025723OtherRAILROAD MEDICARE
VA000579T54Medicare PIN
VA192953OtherBCBS PHYSICAL THERAPY