Healthcare Provider Details

I. General information

NPI: 1417516907
Provider Name (Legal Business Name): SCOTT ALLAN BRADLEY JR. PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 03/12/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15751 SAN CARLOS BLVD STE 4
FORT MYERS FL
33908-3315
US

IV. Provider business mailing address

14411 METRO PKWY UNIT 102
FORT MYERS FL
33912-4365
US

V. Phone/Fax

Practice location:
  • Phone: 239-337-2739
  • Fax:
Mailing address:
  • Phone: 239-292-6498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT34297
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License NumberPT34297
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: