Provider Demographics
NPI:1487224390
Name:BRIDGES, JESSICA (PTA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BRIDGES
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 1:265 W CLICK AVE
Mailing Address - Street 2:
Mailing Address - City:PUXICO
Mailing Address - State:MO
Mailing Address - Zip Code:63960-8405
Mailing Address - Country:US
Mailing Address - Phone:573-421-4845
Mailing Address - Fax:
Practice Address - Street 1:265 W CLICK AVE
Practice Address - Street 2:
Practice Address - City:PUXICO
Practice Address - State:MO
Practice Address - Zip Code:63960-8405
Practice Address - Country:US
Practice Address - Phone:573-421-4845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019039372225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant