Healthcare Provider Details

I. General information

NPI: 1114833407
Provider Name (Legal Business Name): BRADLEY JAREGA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4830 LANDER RD
CHAGRIN FALLS OH
44022-2145
US

IV. Provider business mailing address

4830 LANDER RD
CHAGRIN FALLS OH
44022-2145
US

V. Phone/Fax

Practice location:
  • Phone: 440-823-6565
  • Fax:
Mailing address:
  • Phone: 440-823-6565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License NumberRN.467978
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: