Healthcare Provider Details

I. General information

NPI: 1598640625
Provider Name (Legal Business Name): BRADLEY OWAKA DPT, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2025
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 CHAIN BRIDGE RD STE 201
OAKTON VA
22124-3040
US

IV. Provider business mailing address

12701 FAIR LAKES CIR STE 102
FAIRFAX VA
22033-4913
US

V. Phone/Fax

Practice location:
  • Phone: 703-242-6460
  • Fax: 703-242-6463
Mailing address:
  • Phone: 703-242-6460
  • Fax: 703-242-6463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305217309
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: