Provider Demographics
NPI:1457940553
Name:TOWNSEND, BRIDGETTE
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 240
Mailing Address - Street 2:
Mailing Address - City:CARNEY
Mailing Address - State:OK
Mailing Address - Zip Code:74832-0240
Mailing Address - Country:US
Mailing Address - Phone:405-865-2344
Mailing Address - Fax:405-865-2345
Practice Address - Street 1:204 S CARNEY
Practice Address - Street 2:
Practice Address - City:CARNEY
Practice Address - State:OK
Practice Address - Zip Code:74832-9625
Practice Address - Country:US
Practice Address - Phone:405-865-2344
Practice Address - Fax:405-865-2345
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2293225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist