Provider Demographics
NPI:1639279599
Name:BRIDGE POPE, TAWNY L (PT)
Entity Type:Individual
Prefix:
First Name:TAWNY
Middle Name:L
Last Name:BRIDGE POPE
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 1:1514 12TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7420
Mailing Address - Country:US
Mailing Address - Phone:360-752-2673
Mailing Address - Fax:360-752-0271
Practice Address - Street 1:1514 12TH ST STE 103
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7420
Practice Address - Country:US
Practice Address - Phone:360-752-2673
Practice Address - Fax:360-752-0271
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32472225100000X
WA60068485225100000X
NV1497225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist