Provider Demographics
NPI:1235386210
Name:PARTRIDGE, BOBBETTE GRACE (LMT,MMP)
Entity Type:Individual
Prefix:MS
First Name:BOBBETTE
Middle Name:GRACE
Last Name:PARTRIDGE
Suffix:
Gender:F
Credentials:LMT,MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 22ND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4010
Mailing Address - Country:US
Mailing Address - Phone:601-482-1008
Mailing Address - Fax:601-482-3444
Practice Address - Street 1:1201 22ND AVE STE A
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4010
Practice Address - Country:US
Practice Address - Phone:601-482-1008
Practice Address - Fax:601-482-3444
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSLMT 359172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist