Provider Demographics
NPI:1013189745
Name:BOY, BRIDGET C (PTA)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:C
Last Name:BOY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:
Other - Last Name:VOIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:2719 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-4237
Mailing Address - Country:US
Mailing Address - Phone:920-207-4224
Mailing Address - Fax:
Practice Address - Street 1:2719 CENTER AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-4237
Practice Address - Country:US
Practice Address - Phone:920-207-4224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2018-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI902-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40461800Medicaid