Provider Demographics
NPI:1447786512
Name:WHITE, BRIDGET ANN (ATC)
Entity Type:Individual
Prefix:MISS
First Name:BRIDGET
Middle Name:ANN
Last Name:WHITE
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 1:5842 S NAGLE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-3404
Mailing Address - Country:US
Mailing Address - Phone:773-814-1324
Mailing Address - Fax:
Practice Address - Street 1:5842 S NAGLE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-3404
Practice Address - Country:US
Practice Address - Phone:773-814-1324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer