Provider Demographics
NPI:1205121613
Name:NEWSUM, BRIDGET MARIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:MARIE
Last Name:NEWSUM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:MARIE
Other - Last Name:CARRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 95004
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33804-5004
Mailing Address - Country:US
Mailing Address - Phone:863-680-7000
Mailing Address - Fax:866-264-8519
Practice Address - Street 1:2190 E COUNTY ROAD 540A
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-3740
Practice Address - Country:US
Practice Address - Phone:863-607-3738
Practice Address - Fax:863-607-4030
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26446225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist