Provider Demographics
NPI:1831309962
Name:LIKENS, BRIDGETTE DENISE (P T)
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:DENISE
Last Name:LIKENS
Suffix:
Gender:F
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5548 PECOS LN
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47805-9688
Mailing Address - Country:US
Mailing Address - Phone:812-553-0577
Mailing Address - Fax:812-446-3896
Practice Address - Street 1:3736 S 4TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-5507
Practice Address - Country:US
Practice Address - Phone:812-242-1994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05006941A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist