Provider Demographics
NPI:1295099802
Name:BRIDGES, KACI L (PT, CHT)
Entity type:Individual
Prefix:
First Name:KACI
Middle Name:L
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:PT, CHT
Other - Prefix:
Other - First Name:KACI
Other - Middle Name:L
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 MEDICAL DR NE STE 101
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30121-8005
Mailing Address - Country:US
Mailing Address - Phone:770-386-5221
Mailing Address - Fax:770-386-1128
Practice Address - Street 1:15 MEDICAL DR NE STE 101
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30121
Practice Address - Country:US
Practice Address - Phone:770-386-5221
Practice Address - Fax:770-386-1128
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA51862251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand