Provider Demographics
NPI:1568348886
Name:BRIDGES, LARA NICHOLE (NMP)
Entity type:Individual
Prefix:MRS
First Name:LARA
Middle Name:NICHOLE
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:NMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 VARDEN DR STE F
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-5297
Mailing Address - Country:US
Mailing Address - Phone:803-226-3033
Mailing Address - Fax:
Practice Address - Street 1:37 VARDEN DR STE F
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-5297
Practice Address - Country:US
Practice Address - Phone:803-226-3033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-12
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13157225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist