Provider Demographics
NPI:1982398087
Name:BRIDGES, MCKENZIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 AZALEA DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-4745
Mailing Address - Country:US
Mailing Address - Phone:678-215-1387
Mailing Address - Fax:
Practice Address - Street 1:6667 VERNON WOODS DR STE A14
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-3236
Practice Address - Country:US
Practice Address - Phone:404-425-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT016597225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist