Provider Demographics
NPI:1396265922
Name:BIDEGAINBERRY, AIMEE ELYSE (DPT)
Entity type:Individual
Prefix:DR
First Name:AIMEE
Middle Name:ELYSE
Last Name:BIDEGAINBERRY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2435 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-2302
Mailing Address - Country:US
Mailing Address - Phone:415-810-9099
Mailing Address - Fax:
Practice Address - Street 1:5767 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-4208
Practice Address - Country:US
Practice Address - Phone:415-810-9099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-24
Last Update Date:2017-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293034225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist