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General NPI Number Information
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NPI Number | 1033303862
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Entity Type | Individual
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Provider Name | DOUGLAS BRADLEY PT, CSCS
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Gender | Male
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Dates
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Enumeration Date | 09/05/2007
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 313 N WEBER RD
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City | BOLINGBROOK
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State | IL
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Zip | 60490-1569
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Country | US
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Telephone | 630-771-0850
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Fax | 630-771-0852
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Provider Business Mailing Address
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Address Line | 2001 BUTTERFIELD RD STE 1600
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-1211
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 05007954A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070009229
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License Number State | IL
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