Provider Demographics
NPI:1568914430
Name:DEEM, BRIDGETTE M
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:M
Last Name:DEEM
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 1:4512 QUAIL HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-6613
Mailing Address - Country:US
Mailing Address - Phone:817-266-5278
Mailing Address - Fax:
Practice Address - Street 1:4512 QUAIL HOLLOW CT
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-6613
Practice Address - Country:US
Practice Address - Phone:817-266-5278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1281235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist