Provider Demographics
NPI:1972373660
Name:BRIDGEWATER, IESHA MICHELLE
Entity type:Individual
Prefix:
First Name:IESHA
Middle Name:MICHELLE
Last Name:BRIDGEWATER
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 1:210 EVELYN AVE
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70363-5434
Mailing Address - Country:US
Mailing Address - Phone:985-217-2006
Mailing Address - Fax:
Practice Address - Street 1:1134 BARROW ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-5608
Practice Address - Country:US
Practice Address - Phone:985-217-2006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist