Healthcare Provider Details

I. General information

NPI: 1831723238
Provider Name (Legal Business Name): BRADLEY CRUM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2020
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 WALNUT ST
ATHENS PA
18810-1735
US

IV. Provider business mailing address

115 CENTRAL AVE FL 2
ATHENS PA
18810-1103
US

V. Phone/Fax

Practice location:
  • Phone: 570-888-0057
  • Fax:
Mailing address:
  • Phone: 570-979-6799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT034426
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: