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General NPI Number Information
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NPI Number | 1083189559
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Entity Type | Individual
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Provider Name | BRADLEY WILT DPT
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Gender | Male
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Dates
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Enumeration Date | 10/10/2018
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Last Update Date | 10/10/2018
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Provider Practice Location Address
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Address Line | 5855 MONROE ST
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City | SYLVANIA
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State | OH
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Zip | 43560-2269
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Country | US
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Telephone | 419-276-7130
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Fax |
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Provider Business Mailing Address
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Address Line | 4851 S ARVILLA DR
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City | TOLEDO
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State | OH
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Zip | 43623-1011
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Country | US
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Telephone | 216-973-5170
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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 | 5501017152
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License Number State | MI
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