Provider Demographics
NPI:1730369976
Name:GAINES, BRIDGETT M (MPT)
Entity type:Individual
Prefix:MRS
First Name:BRIDGETT
Middle Name:M
Last Name:GAINES
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:BRIDGETT
Other - Middle Name:A
Other - Last Name:MEYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:PO BOX 776
Mailing Address - Street 2:
Mailing Address - City:SONOITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85637-0776
Mailing Address - Country:US
Mailing Address - Phone:520-237-8091
Mailing Address - Fax:
Practice Address - Street 1:50 SHERWOOD FOREST LANE
Practice Address - Street 2:
Practice Address - City:SONOITA
Practice Address - State:AZ
Practice Address - Zip Code:85637-0776
Practice Address - Country:US
Practice Address - Phone:520-237-8091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2011-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2699225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ27645Medicare PIN