Provider Demographics
NPI:1942334743
Name:ELLINGSON, BRIDGID (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:BRIDGID
Middle Name:
Last Name:ELLINGSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:BRIDGID
Other - Middle Name:
Other - Last Name:ROONEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4548 N CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2112
Mailing Address - Country:US
Mailing Address - Phone:773-755-9214
Mailing Address - Fax:773-755-9216
Practice Address - Street 1:1636 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3018
Practice Address - Country:US
Practice Address - Phone:773-755-9214
Practice Address - Fax:773-755-9216
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070008179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ30319Medicare UPIN
ILK12891Medicare ID - Type Unspecified