Provider Demographics
NPI:1760653075
Name:BRIDGES, KEVIN ROSS (DPT)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ROSS
Last Name:BRIDGES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
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Mailing Address - Street 1:800 CRESCENT CENTRE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7285
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:615-221-9054
Practice Address - Street 1:2844 ESSARY DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-2401
Practice Address - Country:US
Practice Address - Phone:865-584-1031
Practice Address - Fax:865-584-1032
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8466225100000X
MI55010137082251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I651186Medicare PIN