Provider Demographics
NPI:1659931723
Name:BRIDGEFORD, MITCHELL RYAN (PT)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:RYAN
Last Name:BRIDGEFORD
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 1:15 8TH AVE N
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55343-7670
Mailing Address - Country:US
Mailing Address - Phone:529-933-5085
Mailing Address - Fax:
Practice Address - Street 1:15 8TH AVE N
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55343-7670
Practice Address - Country:US
Practice Address - Phone:529-933-5085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2264225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist