Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 2305002246 | VA |
NPI | 1285951624 |
---|---|
Provider Name | Ms. Pamela R. Bridgeforth |
First Address | Richmond, VA 23224-2827 |
Second Address | Midlothian, VA 23114-5551 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2010 |
Last Update Date | 26/04/2010 |