Provider Demographics
NPI:1326246331
Name:BEVERS, BRIDGET G (PTA)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:G
Last Name:BEVERS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2438 GRAINGER PKWY
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-9522
Mailing Address - Country:US
Mailing Address - Phone:402-328-9944
Mailing Address - Fax:
Practice Address - Street 1:1001 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-2251
Practice Address - Country:US
Practice Address - Phone:615-896-6400
Practice Address - Fax:615-896-5177
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE684225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant