Healthcare Provider Details

I. General information

NPI: 1548361017
Provider Name (Legal Business Name): JENNIFER MARIE BRADLEY M.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5907 WECKERLY RD
WHITEHOUSE OH
43571-9648
US

IV. Provider business mailing address

1560 HENTHORNE DR
MAUMEE OH
43537-1371
US

V. Phone/Fax

Practice location:
  • Phone: 419-877-5144
  • Fax: 419-877-4780
Mailing address:
  • Phone: 419-866-5196
  • Fax: 419-866-5663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 070948
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: