Provider Demographics
NPI:1649745159
Name:JUHNKE, BRIDGET ANN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:ANN
Last Name:JUHNKE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 49TH ST S APT 105
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-4528
Mailing Address - Country:US
Mailing Address - Phone:320-522-2262
Mailing Address - Fax:
Practice Address - Street 1:4450 31ST AVE S STE 104
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-4557
Practice Address - Country:US
Practice Address - Phone:701-451-9417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11326225100000X
ND2167225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND2167OtherPHYSICAL THERAPY LICENSE
MN11326OtherMN STATE PHYSICAL THERAPY LICENSE NUMBER