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General NPI Number Information
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NPI Number | 1003168576
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Entity Type | Individual
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Provider Name | TORI BRADLEY MS, ATC, LAT, LMT
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Gender | Female
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Dates
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Enumeration Date | 10/09/2012
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Last Update Date | 10/09/2012
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Provider Practice Location Address
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Address Line | 4700 KIRBY RD
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City | ROWLETT
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State | TX
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Zip | 75088-5191
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Country | US
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Telephone | 972-463-1712
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Fax |
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Provider Business Mailing Address
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Address Line | 5501 LAKEVIEW PKWY APT 333 #333
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City | ROWLETT
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State | TX
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Zip | 75088-4119
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Country | US
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Telephone | 806-231-7038
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 42377
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License Number State | TX
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