Healthcare Provider Details

I. General information

NPI: 1386735090
Provider Name (Legal Business Name): BRADLEY W BENDER MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1005
PAGO PAGO AMERICAN SAMOA
96799
UM

IV. Provider business mailing address

PO BOX 1005
PAGO PAGO AMERICAN SAMOA
96799
UM

V. Phone/Fax

Practice location:
  • Phone: 684-699-3730
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number113699
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2668
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: