Provider Demographics
NPI:1679982904
Name:CHINN, BRIDGET (DPT)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:CHINN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:
Other - Last Name:MOODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 W DORRIS MOORE DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276-9747
Mailing Address - Country:US
Mailing Address - Phone:315-854-7306
Mailing Address - Fax:
Practice Address - Street 1:540 NOEL AVE
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1386
Practice Address - Country:US
Practice Address - Phone:270-885-7887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007634225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist