Bridget Ann Gilbreth, PTA
Individual provider Active NPI Physical Therapy Assistant · Keyesport, IL
NPI 1649502014 · NPPES record last updated May 18, 2016
Key facts
- NPI
- 1649502014
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 160004982 (IL)
- Practice address
- 1790 1St Ave
Keyesport, IL 62253-2020 - Phone
- (618) 616-2211
- NPI assigned
- Feb 9, 2010
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 160004982 | IL | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 160004982 | IL | Yes |
Addresses
Primary practice location
1790 1St Ave
Keyesport, IL 62253-2020
Mailing address
1305 4TH St
Keyesport, IL 62253-2100
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 18, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.