MEDICARE: MRS. ANDREA JEAN BRADLEY

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	2251P0200X	Pediatric Physical Therapist	08871	OH

General Provider Information

NPI Number	:	1881140069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANDREA JEAN BRADLEY

Provider Business Mailing Address
First Line	:	2400 MCVEY CT
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-2835
Country	:	US
Telephone Number	:	614-284-6328
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 MCVEY CT
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-2835
Country	:	US
Telephone Number	:	614-284-6328
Fax Number	:

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

Provider Enumeration Date	:	08/29/2016
Last Update Date	:	08/29/2016

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