Provider Demographics
NPI:1922194539
Name:BRIDGES, LESLIE C (PT)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:C
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 KENNEDY CT
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-3351
Mailing Address - Country:US
Mailing Address - Phone:770-378-0693
Mailing Address - Fax:770-807-2708
Practice Address - Street 1:805 KENNEDY CT
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-3351
Practice Address - Country:US
Practice Address - Phone:770-378-0693
Practice Address - Fax:770-807-2708
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0002259225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist