Individual
KELLY JAMES BRIDGEWATER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1102 ELM ST, MISSION, TX 78572-4442
(956) 862-0074
Mailing address
1102 ELM ST, MISSION, TX 78572-4442
(956) 862-0074
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
209311
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2019311
STATE LICENSE NUMBER
TX
Enumeration date
02/17/2015
Last updated
05/17/2026
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