Provider Demographics
NPI:1679833891
Name:ESWEIN, AMY BRIDGES
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BRIDGES
Last Name:ESWEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 SW 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76067-5117
Mailing Address - Country:US
Mailing Address - Phone:940-328-1187
Mailing Address - Fax:940-328-0579
Practice Address - Street 1:711 SW 1ST ST
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067-5117
Practice Address - Country:US
Practice Address - Phone:940-328-1187
Practice Address - Fax:940-328-0579
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1045359225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist