Provider Demographics
NPI:1932377066
Name:NEIDER, BRIDGIT ELISE (PTA)
Entity type:Individual
Prefix:MRS
First Name:BRIDGIT
Middle Name:ELISE
Last Name:NEIDER
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 1:1802 3RD AVE N
Mailing Address - Street 2:
Mailing Address - City:ESTHERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:51334-2082
Mailing Address - Country:US
Mailing Address - Phone:712-209-3486
Mailing Address - Fax:
Practice Address - Street 1:1802 3RD AVE N
Practice Address - Street 2:
Practice Address - City:ESTHERVILLE
Practice Address - State:IA
Practice Address - Zip Code:51334-2082
Practice Address - Country:US
Practice Address - Phone:712-209-3486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00868225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant