Provider Demographics
NPI:1962428698
Name:MAHAN, BRIDGID MARIE (PT, DPT, OCS,SCS)
Entity type:Individual
Prefix:MS
First Name:BRIDGID
Middle Name:MARIE
Last Name:MAHAN
Suffix:
Gender:F
Credentials:PT, DPT, OCS,SCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6008 BROWNSBORO PARK BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-1295
Mailing Address - Country:US
Mailing Address - Phone:502-899-4760
Mailing Address - Fax:502-899-4719
Practice Address - Street 1:6008 BROWNSBORO PARK BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-1295
Practice Address - Country:US
Practice Address - Phone:502-899-4760
Practice Address - Fax:502-899-4719
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0040502251X0800X, 2251S0007X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY205097932OtherHUMANA
KY000000505134OtherANTHEM
KY000000505134OtherANTHEM