Provider Demographics
NPI:1255500658
Name:BAINBRIDGE, HILARY JAYNE (ATC)
Entity Type:Individual
Prefix:
First Name:HILARY
Middle Name:JAYNE
Last Name:BAINBRIDGE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 SHARKS BLVD
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-6465
Mailing Address - Country:US
Mailing Address - Phone:772-564-4248
Mailing Address - Fax:772-564-4334
Practice Address - Street 1:9001 SHARKS BLVD
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-6465
Practice Address - Country:US
Practice Address - Phone:772-564-4248
Practice Address - Fax:772-564-4334
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 18752255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL 1875OtherLAT