Healthcare Provider Details

I. General information

NPI: 1629907795
Provider Name (Legal Business Name): BRADLEY ALLAN PEARSON ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 JERSEY ST
BOSTON MA
02215-4148
US

IV. Provider business mailing address

4 JERSEY ST
BOSTON MA
02215-4148
US

V. Phone/Fax

Practice location:
  • Phone: 857-366-0794
  • Fax:
Mailing address:
  • Phone: 857-366-0794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberATL1383
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: