Provider Demographics
NPI:1932141371
Name:BUNKER, BRIDGETTE RENEE (DPT)
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:RENEE
Last Name:BUNKER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BRIDGETTE
Other - Middle Name:R
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 530062
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-0062
Mailing Address - Country:US
Mailing Address - Phone:843-695-6071
Mailing Address - Fax:843-569-5879
Practice Address - Street 1:7611 SAINT ANDREWS RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2834
Practice Address - Country:US
Practice Address - Phone:803-714-3300
Practice Address - Fax:803-626-9356
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9985225100000X
SC9435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH4129Medicaid