Provider Demographics
NPI:1538813928
Name:MATTES, BRIDGET COLLEEN (DPT)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:COLLEEN
Last Name:MATTES
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:PO BOX 2860
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88311-2860
Mailing Address - Country:US
Mailing Address - Phone:575-437-3351
Mailing Address - Fax:575-437-2622
Practice Address - Street 1:126 S CANYON ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-5733
Practice Address - Country:US
Practice Address - Phone:575-628-0503
Practice Address - Fax:575-628-3073
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT22007225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist