Provider Demographics
NPI:1063787521
Name:BRIDGES, RACHEL ELEANOR
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ELEANOR
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:
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 251
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68354-0251
Mailing Address - Country:US
Mailing Address - Phone:402-759-1326
Mailing Address - Fax:
Practice Address - Street 1:811 W 2ND ST
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:IL
Practice Address - Zip Code:61010-1464
Practice Address - Country:US
Practice Address - Phone:815-234-2511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160005941225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant