Bridget Rose, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

160005138 Issued in IL

Practice address

600 W Owens St
Carbondale, IL 62901-1246

Phone

(618) 967-5186

NPI assigned

Nov 4, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Miss Bridget Suzanne Shepherd Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1446595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446595200000",
    "number": "1003289620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 W OWENS ST",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011246",
            "telephone_number": "618-967-5186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 W OWENS ST",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011246",
            "telephone_number": "618-967-5186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSE",
        "first_name": "BRIDGET",
        "name_prefix": "Mrs.",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-11-04",
        "last_updated": "2015-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": "160005138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRIDGET",
            "last_name": "SHEPHERD",
            "middle_name": "SUZANNE",
            "prefix": "MISS",
            "credential": "PTA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Laura Ann Robison, MSOTR/L
• Michael Rohling, MS, LCPC
• Bonnie Rooney
• Markida Jenise Roper
• Anne Marie Rose, FNP
• Hannah Rose, LCPC
• Jennifer Ari Rose, AMFT LPC
• Jennifer Kay Rose, M.D.
• Mary R. Rosenberg, PH.D.
• Jeremy Rosene

• Physical Therapy Assistant in Carbondale, IL
• Providers in Carbondale, IL by specialty
• Physical Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.