Individual
JALEN BRIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2410 SUSANNAH ST, JOHNSON CITY, TN 37601-1748
(423) 282-9011
Mailing address
2410 SUSANNAH ST, JOHNSON CITY, TN 37601-1748
(423) 282-9011
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
12704
TN
Other
Enumeration date
02/19/2020
Last updated
02/27/2020
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