Provider Demographics
NPI:1518431709
Name:BRIDGES, VERONICA
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12712 LEE BEN RD
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21087-1128
Mailing Address - Country:US
Mailing Address - Phone:410-592-5999
Mailing Address - Fax:
Practice Address - Street 1:12712 LEE BEN RD
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21087-1128
Practice Address - Country:US
Practice Address - Phone:410-592-5999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer