Provider Demographics
NPI:1134532781
Name:BRIDGES, ELLEN ELIZABETH (PTA)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:ELIZABETH
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 S NC HIGHWAY 119
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-9565
Mailing Address - Country:US
Mailing Address - Phone:336-578-5815
Mailing Address - Fax:
Practice Address - Street 1:708 S SELLARS MILL RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-4316
Practice Address - Country:US
Practice Address - Phone:843-251-2324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5297225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant