Provider Demographics
NPI:1902238751
Name:QUINNDICARLO, BRIDGET (PTA)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:QUINNDICARLO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:MA
Mailing Address - Zip Code:01226-1407
Mailing Address - Country:US
Mailing Address - Phone:413-684-0879
Mailing Address - Fax:
Practice Address - Street 1:151 CHRISTIAN HILL RD
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1108
Practice Address - Country:US
Practice Address - Phone:413-528-7121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-04
Last Update Date:2013-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8823225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant