Healthcare Provider Details

I. General information

NPI: 1558637074
Provider Name (Legal Business Name): BRADLEY DAIL BANKER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 W WENDOVER AVE
GREENSBORO NC
27408-8401
US

IV. Provider business mailing address

319 W WENDOVER AVE
GREENSBORO NC
27408-8401
US

V. Phone/Fax

Practice location:
  • Phone: 336-274-5006
  • Fax: 336-274-5033
Mailing address:
  • Phone: 336-274-5006
  • Fax: 336-274-5033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP10427
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: