Healthcare Provider Details

I. General information

NPI: 1912835869
Provider Name (Legal Business Name): BRADLEY HANSON PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 MADISON PARK DR STE 100
GLEN BURNIE MD
21061-6355
US

IV. Provider business mailing address

713 BAYLOR RD
GLEN BURNIE MD
21061-4653
US

V. Phone/Fax

Practice location:
  • Phone: 443-969-7119
  • Fax:
Mailing address:
  • Phone: 410-562-1910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA4750
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: