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General NPI Number Information
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NPI Number | 1104472752
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Entity Type | Organization
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Legal Business Name | BRADLEY PHYSIOTHERAPY PC
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Dates
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Enumeration Date | 08/09/2019
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Last Update Date | 12/18/2020
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Provider Practice Location Address
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Address Line | 19732 MACARTHUR BLVD STE 125
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City | IRVINE
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State | CA
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Zip | 92612-2455
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Country | US
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Telephone | 949-644-2022
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Fax | 949-644-1914
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Provider Business Mailing Address
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Address Line | 19732 MACARTHUR BLVD STE 125
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City | IRVINE
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State | CA
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Zip | 92612-2455
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Country | US
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Telephone | 949-644-2022
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Fax | 949-644-1914
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Authorized Official
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Title or Position | OWNER
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Name | KATHY BRADLEY
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Credential | DPT
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Telephone | 949-644-2022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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