1003477274 NPI number — BRIDGET GILBERTSON PT, DPT

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003477274 NPI number — BRIDGET GILBERTSON PT, DPT

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

GILBERTSON

Provider First Name:

BRIDGET

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

PT, DPT

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1003477274

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/08/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

SWORD HEALTH INC., 13937 SPRAGUE LANE

Provider Second Line Business Mailing Address:

SUITE 100

Provider Business Mailing Address City Name:

DRAPER

Provider Business Mailing Address State Name:

UT

Provider Business Mailing Address Postal Code:

84020

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

385-308-8034

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

2931 N MAYWOOD AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

BOISE

Provider Business Practice Location Address State Name:

ID

Provider Business Practice Location Address Postal Code:

83704-5681

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

385-498-1740

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

06/27/2019

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 225100000X , with the licence number:  TPPT370 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2251X0800X , with the licence number: 305694 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2251X0800X , with the licence number: PT020971 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2251X0800X , with the licence number: PT032114 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2251X0800X , with the licence number: 051876 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2251X0800X , with the licence number: 1390140 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2251X0800X , with the licence number: 070028144 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2251X0800X , with the licence number: 6248 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 225100000X , with the licence number: PTH11831 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .