Healthcare Provider Details

I. General information

NPI: 1043312911
Provider Name (Legal Business Name): BRADLEY A. SMITH MSPT,SCS,ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 WESLEY CIR
NOBLESVILLE IN
46062-9077
US

IV. Provider business mailing address

117 WESLEY CIR
NOBLESVILLE IN
46062-9077
US

V. Phone/Fax

Practice location:
  • Phone: 317-679-2809
  • Fax: 317-877-0320
Mailing address:
  • Phone: 317-679-2809
  • Fax: 317-877-0320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05001715A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: