Provider Demographics
NPI:1871562785
Name:SCHOLLJEGERDES, BRIDGET A (PT)
Entity type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:A
Last Name:SCHOLLJEGERDES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 S. LOCUST STREET
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-0000
Mailing Address - Country:US
Mailing Address - Phone:575-521-4296
Mailing Address - Fax:575-521-4494
Practice Address - Street 1:2404 S. LOCUST STREET
Practice Address - Street 2:SUITE 5
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-0000
Practice Address - Country:US
Practice Address - Phone:575-521-4296
Practice Address - Fax:575-521-4494
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1373225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist