Provider Demographics
NPI:1619016771
Name:MOREHOUSE, BRIDGET (PT)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:MOREHOUSE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2222
Mailing Address - Fax:
Practice Address - Street 1:313 N WEBER RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60490-1569
Practice Address - Country:US
Practice Address - Phone:630-771-0850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9649024225100000X
IL070-017626225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216859039Medicare PIN
IL202845073Medicare PIN
IL211082017Medicare PIN
IL214708025Medicare PIN
WI000786507Medicare PIN
IL216860023Medicare PIN
IL212623015Medicare PIN
IL212622018Medicare PIN