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Individual

DERRICK BRIDGES

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
ATC,LAT

Contact information

Practice address
11200 GOVERNOR MANLY WAY, RALEIGH, NC 27614-8599
(919) 562-9410
Mailing address
11200 GOVERNOR MANLY WAY, RALEIGH, NC 27614-8599

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2272
NC

Other

Enumeration date
07/13/2013
Last updated
07/13/2013
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