Healthcare Provider Details

I. General information

NPI: 1821033093
Provider Name (Legal Business Name): BRADLEY KERR BRYAN MS,PT, CHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 05/18/2020
Certification Date: 05/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HIOAKS RD SUITE B
RICHMOND VA
23225-4061
US

IV. Provider business mailing address

1115 BOULDERS PKWY STE 200
NORTH CHESTERFIELD VA
23225-4067
US

V. Phone/Fax

Practice location:
  • Phone: 804-330-8165
  • Fax: 804-330-5829
Mailing address:
  • Phone: 804-915-4602
  • Fax: 804-327-8496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305001814
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: