Provider Demographics
NPI:1609131895
Name:BRIDGE, PATRICK (PT)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:BRIDGE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:STE. 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:3100 HAWORTH AVE
Practice Address - Street 2:SUITE 270
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2093
Practice Address - Country:US
Practice Address - Phone:503-538-4805
Practice Address - Fax:503-538-4878
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6848225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500647048Medicaid
ORP01286216OtherRR MEDICARE
ORP01286216OtherRR MEDICARE
ORR171367Medicare PIN
ORR183659Medicare PIN
ORR166933Medicare PIN