Healthcare Provider Details

I. General information

NPI: 1821221391
Provider Name (Legal Business Name): BRADLEY PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2009
Last Update Date: 04/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 ROBIN LANE
WAUSAU WI
54401-7158
US

IV. Provider business mailing address

2003 ROBIN LN
WAUSAU WI
54401-7158
US

V. Phone/Fax

Practice location:
  • Phone: 715-845-3775
  • Fax: 715-848-9015
Mailing address:
  • Phone: 715-845-3775
  • Fax: 715-848-9015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2469-024
License Number StateWI

VIII. Authorized Official

Name: MS. CHRISTINE MARIE BISGROVE
Title or Position: BUSINESS ADMINISTRATOR
Credential:
Phone: 715-845-3775