Provider Demographics
NPI:1538358866
Name:BRIDGES PHYSICAL THERAPY & WELLNESS, LLC
Entity type:Organization
Organization Name:BRIDGES PHYSICAL THERAPY & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:PROF
Authorized Official - First Name:JODI
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:LEMOINE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:504-906-3739
Mailing Address - Street 1:801 W JUDGE PEREZ DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-4805
Mailing Address - Country:US
Mailing Address - Phone:504-278-7567
Mailing Address - Fax:504-278-7569
Practice Address - Street 1:801 W JUDGE PEREZ DR
Practice Address - Street 2:SUITE A
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-4805
Practice Address - Country:US
Practice Address - Phone:504-278-7567
Practice Address - Fax:504-278-7569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06834R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DB88Medicare PIN