Provider Demographics
NPI:1134777907
Name:WARD, BRIDGET (MPS, ATC)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:WARD
Suffix:
Gender:F
Credentials:MPS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MARINO RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-5518
Mailing Address - Country:US
Mailing Address - Phone:702-491-7682
Mailing Address - Fax:
Practice Address - Street 1:441 E FORDHAM RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5149
Practice Address - Country:US
Practice Address - Phone:702-491-7682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2941-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer