Provider Demographics
NPI:1881025716
Name:BRIDGEWATER, RAWLINS (PT, DPT)
Entity Type:Individual
Prefix:
First Name:RAWLINS
Middle Name:
Last Name:BRIDGEWATER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 AIRPORT RD
Mailing Address - Street 2:APT 1123
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2815
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2530 BOBCAT VILLAGE CENTER RD UNIT C
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34288-8475
Practice Address - Country:US
Practice Address - Phone:941-426-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9984225100000X
ALPTH6925225100000X
FLPT29085225100000X
TX1241363225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist