MEDICARE: DR. BRADLY DOUGLAS RADLE PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2810	NV
2	225100000X	Physical Therapist	8510286-2401	UT

General Provider Information

NPI Number	:	1215277660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLY DOUGLAS RADLE PT, DPT

Provider Business Mailing Address
First Line	:	785 MILL SHADOW DR
Second Line	:
City	:	KAYSVILLE
State	:	UT
Zip	:	84037-4171
Country	:	US
Telephone Number	:	801-549-8724
Fax Number	:

Provider Business Practice Location Address
First Line	:	5850 POLARIS AVE STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3185
Country	:	US
Telephone Number	:	702-739-9957
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2013
Last Update Date	:	02/21/2013

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