Provider Demographics
NPI:1760787485
Name:MRAZ, BRIDGET (PTA)
Entity Type:Individual
Prefix:MS
First Name:BRIDGET
Middle Name:
Last Name:MRAZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 CLINTON PKWY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4730
Mailing Address - Country:US
Mailing Address - Phone:601-926-2018
Mailing Address - Fax:601-924-9746
Practice Address - Street 1:108 CLINTON PKWY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4730
Practice Address - Country:US
Practice Address - Phone:601-926-2018
Practice Address - Fax:601-924-9746
Is Sole Proprietor?:No
Enumeration Date:2011-01-12
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPTA4265225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant